Associations between meal and snack frequency and overweight and abdominal obesity in US children and adolescents from National Health and Nutrition Examination Survey (NHANES) 2003–2012

The effect of discretionary snack consumption on overall energy intake, weight status, and diet quality: A systematic review

The consumption frequency and portion size of discretionary snacks are thought to contribute to a greater food intake and risk of overweight or obesity in the developed world but evidence from epidemiological studies is inconclusive. To investigate this, we systematically evaluated evidence on the effects of discretionary snack consumption on weight status, energy intake, and diet quality. Articles involving discretionary snacks reported against the outcome measures of any primary, peer-reviewed study using human participants from free-living conditions for all age groups were included. A total of 14,780 titles were identified and 40 eligible publications were identified. Three key outcomes were reported: weight status (n = 35), energy intake (n = 11), and diet quality (n = 3). Increased discretionary snack consumption may contribute modestly to energy intake, however, there is a lack of consistent associations with increased weight/BMI. Although cross-sectional analyses offered conflicting findings, longitudinal studies in adults showed a consistent positive relationship between discretionary snack intake and increasing weight or body mass index. Given that experimental findings suggest reducing the size of discretionary snacks could lead to decreased consumption and subsequent energy intake, food policy makers and manufacturers may find it valuable to consider altering the portion and/or packaging size of discretionary snacks.

Social desirability bias is related to children's energy intake in a laboratory test meal paradigm

Dietary intake is notoriously difficult to measure in children. Laboratory test meals address some of the methodological concerns of self-report methods, but may also be susceptible to social desirability bias, referring to the tendency for individuals to adjust their behaviors in order to be perceived more positively. The aim of the current study was to evaluate whether social desirability bias was associated with children's energy intake during a laboratory test meal, and whether this association varied by food type (total caloric intake, snack food intake, fruit/vegetable intake) and sex. A total of 82 children (M age = 9.45 ± 0.85; 50 % girls; 84.1 % rural; 85.4 % White) completed several surveys, including the Children's Social Desirability Scale and had their body composition measured. At lunchtime, they were granted access to a multi-array test meal (>5000 kcal). After adjusting for lean mass, fat mass, depressive symptoms, and parental food restriction, children who reported higher social desirability bias consumed fewer calories from snack foods (B = -11.58, p = .009, semi-partial correlation = -0.28). Boys with higher social desirability bias consumed less calories from fruits and vegetables (B = -6.47, p = .010, semi-partial correlation = -0.411); this association was not significant in girls. The desire to be perceived in a positive manner may influence children's eating behaviors in experimental paradigms. Replication studies with larger, more diverse pediatric samples are needed, as are strategies to reduce the effects of social desirability bias on test meal intake in order to enhance the validity of this dietary assessment approach.

Temporal Dietary Pattern Cluster Membership Varies on Weekdays and Weekends but Both Link to Health

BACKGROUND

Energy and dietary quality are known to differ between weekdays and weekends. Data-driven approaches that incorporate time, amount, and duration of dietary intake have previously been used to partition participants' daily weekday dietary intake time series into clusters representing weekday temporal dietary patterns (TDPs) linked to health indicators in United States adults. Yet, neither the relationship of weekend day TDPs to health indicators nor how the TDP membership may change from weekday to weekend is known.

OBJECTIVES

This study was conducted to determine the association between TDPs on weekdays and weekend days and health indicators [diet quality, waist circumference (WC), body mass index (BMI), and obesity] and their overlap among participants.

METHODS

A weekday and weekend day 24-hour dietary recall of 9494 nonpregnant United States adults aged 20-65 years from the cross-sectional National Health and Nutrition Examination Survey 2007-2018 was used to determine the timing and amount of energy intake. Modified dynamic time warping and kernel k-means algorithm clustered participants into 4 TDPs on weekdays and weekend days. Multivariate regression models determined the associations between TDPs and health indicators, controlling for potential confounders and adjusting for the survey design and multiple comparisons. The percentages of overlap in cluster membership between TDPs on weekdays and weekend days were also determined.

RESULTS

United States adults with a TDP of evenly spaced, energy-balanced eating occasions, representing the TDP of more than one-third of all adults on weekdays and weekends, had significantly higher diet quality, lower BMI, WC, and odds of obesity when compared to those with other TDPs. Membership of most United States adults to TDPs varied from weekdays to weekends.

CONCLUSIONS

Both weekday and weekend TDPs were significantly associated with health indicators. TDP membership of most United States adults was not consistent on weekdays and weekends.

From a toxin to an obesogen: a review of potential obesogenic roles of acrylamide with a mechanistic approach

Obesity and obesity-related disorders such as cancer, type 2 diabetes, and fatty liver have become a global health problem. It is well known that the primary cause of obesity is positive energy balance. In addition, obesity is the consequence of complex gene and environment interactions that result in excess calorie intake being stored as fat. However, it has been revealed that there are other factors contributing to the worsening of obesity. The presence of nontraditional risk factors, such as environmental endocrine-disrupting chemicals, has recently been associated with obesity and comorbidities caused by obesity. The aim of this review was to examine the evidence and potential mechanisms for acrylamide having endocrine-disrupting properties contributing to obesity and obesity-related comorbidities. Recent studies have suggested that exposure to environmental endocrine-disrupting obesogens may be a risk factor contributing to the current obesity epidemic, and that one of these obesogens is acrylamide, an environmental and industrial compound produced by food processing, particularly the processing of foods such as potato chips, and coffee. In addition to the known harmful effects of acrylamide in humans and experimental animals, such as neurotoxicity, genotoxicity, and carcinogenicity, acrylamide also has an obesogenic effect. It has been shown in the literature to a limited extent that acrylamide may disrupt energy metabolism, lipid metabolism, adipogenesis, adipocyte differentiation, and various signaling pathways, and may exacerbate the disturbances in metabolic and biochemical parameters observed as a result of obesity. Acrylamide exerts its main potential obesogenic effects through body weight increase, worsening of the levels of obesity-related blood biomarkers, and induction of adipocyte differentiation and adipogenesis. Additional mechanisms may be discovered. Further experimental studies and prospective cohorts are needed, both to supplement existing knowledge about acrylamide and its effects, and to clarify its established relationship with obesity and its comorbidities.

Temporal Patterns of Diet and Physical Activity and of Diet Alone Have More Numerous Relationships With Health and Disease Status Indicators Compared to Temporal Patterns of Physical Activity Alone

BACKGROUND

Daily temporal patterns of energy intake (temporal dietary patterns [TDPs]) and physical activity (temporal physical activity patterns [TPAPs]) have been independently and jointly (temporal dietary and physical activity patterns [TDPAPs]) associated with health and disease status indicators.

OBJECTIVE

The aim of this study was to compare the number and strength of association between clusters of daily TDPs, TPAPs, and TDPAPs and multiple health and disease status indicators.

DESIGN

This cross-sectional study used 1 reliable weekday dietary recall and 1 random weekday of accelerometer data to partition to create clusters of participants representing the 3 temporal patterns. Four clusters were created via kernel-k means clustering algorithm of the same constrained dynamic time warping distance computed over the time series for each temporal pattern.

PARTICIPANTS/SETTING

From the National Health and Nutrition Examination Survey (2003-2006), 1,836 US adults aged 20 through 65 years who were not pregnant and had valid diet, physical activity, sociodemographic, anthropometric, questionnaire, and health and disease status indicator data were included.

MAIN OUTCOME MEASURES

Health status indicators used as outcome measures were body mass index, waist circumference, fasting plasma glucose, hemoglobin A1c, triglycerides, high-density lipoprotein cholesterol, total cholesterol, and systolic and diastolic blood pressure; disease status indicators included obesity, type 2 diabetes mellitus, and metabolic syndrome.

STATISTICAL ANALYSES PERFORMED

Multivariate regression models determined associations between the clusters representing each pattern and health and disease status indicators, controlling for confounders and adjusting for multiple comparisons. The number of significant differences among clusters and adjusted R2 and Akaike information criterion compared the strength of associations between clusters of patterns and continuous and categorical health and disease status indicators.

RESULTS

TDPAPs showed 21 significant associations with health and disease status indicators, including body mass index, waist circumference, obesity, and type 2 diabetes; TDPs showed 19 significant associations; and TPAPs showed 8 significant associations.

CONCLUSIONS

TDPAPs and TDPs had stronger and more numerous associations with health and disease status indicators compared with TPAPs. Patterns representing the integration of daily dietary habits hold promise for early detection of obesity.

Chrononutrition and metabolic health in children and adolescents: a systematic review and meta-analysis

CONTEXT

Obesity has emerged as a global health issue for the pediatric population, increasing the need to investigate physiopathological aspects to prevent the appearance of its cardiometabolic complications. Chrononutrition is a field of research in nutritional sciences that investigates the health impact of 3 different dimensions of feeding behavior: regularity of meals, frequency, and timing of food intake.

OBJECTIVE

We carried out a systematic review and meta-analysis to investigate the association between chrononutrition in children and adolescents and the risk of overweight/obesity or a cluster of metabolic abnormalities related to glucose and lipid metabolism, blood pressure, and cardiovascular disease risk.

DATA EXTRACTION

A literature search was performed using PubMed, EMBASE, and The Cochrane Library for relevant articles published before August 2022.

DATA ANALYSIS

A total of 64 articles were included in the narrative synthesis (47 cross-sectional and 17 cohort studies), while 16 studies were included in the meta-analysis. Meta-analysis showed that non-daily breakfast consumers (≤6 d/wk) had a higher risk of overweight/obesity (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.08-1.82] compared with daily breakfast eaters (7 d/wk). Similarly, irregular breakfast consumption (only 0-to-3 times/wk) increased the risk of abdominal obesity (waist-to-height ratio ≥ 0.5) compared with regular consumption (5-to-7 times/wk) (OR, 1.38; 95% CI, 1.26-1.49). There was evidence to suggest that a regular frequency of meal consumption (≥4 times/d) is preventive against overweight/obesity development compared with fewer meals (≤3 times/d) (OR, 0.83; 95% CI, 0.70-0.97). In the narrative synthesis, snacking habits showed controversial results, while food timing was the most understudied dimension.

CONCLUSION

Overall, our data indicate a potential implication of chrononutrition in affecting pediatric metabolic health; however, the evidence of this association is limited and heterogeneous. Further prospective and intervention studies with a consistent approach to categorize the exposure are needed to elucidate the importance of chrononutrition for pediatric metabolic health.

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.

The patterns and position of snacking in children in aged 2-12 years: A scoping review

BACKGROUND

Childhood obesity is associated with serious comorbidities during childhood and into adulthood. One potential risk factor for childhood obesity is consumption of unhealthy, energy-dense foods. This scoping review examines evidence on snacking in children aged 2-12years of age and presents the patterns and position of snacking in children's diets.

METHODS

A search of electronic databases (MEDLINE, Web of Science, PubMed, Embase) for articles published from March 2011 to November 2022 was conducted. Articles providing insight into the position of snacking (e.g., energy contribution), or patterns (e.g., location, timing), in children aged 2-12years were included. A quality assessment was conducted and data was synthesised according to data source (nationally representative or other).

RESULTS

Twenty-one articles were included, most (n = 13) reporting nationally representative data. The average number of daily snacks was 3, with 92.9-100.0% of children consuming snacks. Most were consumed in the afternoon (75.2-84.0%) and at home (46.5-67.3%). Snacks frequently consumed were 'fruits and vegetables', 'baked desserts', 'sweets, candy and confectionery', and 'dairy products'. Snacks contributed 231-565 kcal daily, up to a third of daily carbohydrate intake, a quarter of fat intake, and a fifth of protein intake. Snacks provided up to one third of vitamin C intake, one quarter of vitamin E, potassium and magnesium intake, and a fifth of calcium, folic acid, vitamins D and B12, iron and sodium intake.

DISCUSSION

This scoping review provides insight into patterns and position of snacking within children's diets. Snacking plays a significant role in children's diets with multiple snacking occasions occurring throughout a child's day, the overconsumption of which has the potential to increase risk of childhood obesity. Further research is required into the role of snacking, particularly specific foods playing a role in micronutrient intake, and clear guidance for snacking intake in children.

Subclinical Reactive Hypoglycemia with Low Glucose Effectiveness-Why We Cannot Stop Snacking despite Gaining Weight

Obesity has grown worldwide owing to modern obesogenic lifestyles, including frequent snacking. Recently, we studied continuous glucose monitoring in obese/overweight men without diabetes and found that half of them exhibit glucose levels less than 70 mg/dL after a 75-g oral glucose load without notable hypoglycemic symptoms. Interestingly, people with "subclinical reactive hypoglycemia (SRH)" snack more frequently than those without it. Since the ingestion of sugary snacks or drinks could further induce SRH, a vicious cycle of "Snacking begets snacking via SRH" can be formed. Glucose effectiveness (Sg) is an insulin-independent mechanism that contributes to most of the whole-body glucose disposal after an oral glucose load in people without diabetes. Our recent data suggest that both higher and lower Sg are associated with SRH, while the latter but not the former is linked to snacking habits, obesity, and dysglycemia. The present review addresses the possible role of SRH in snacking habits in people with obesity/overweight, taking Sg into account. It is concluded that, for those with low Sg, SRH can be regarded as a link between snacking and obesity. Prevention of SRH by raising Sg might be key to controlling snacking habits and body weight.

Association between diet quality scores and risk of overweight and obesity in children and adolescents

BACKGROUND

This study examined the associations of diet quality assessed by Healthy Eating Index 2015 (HEI-2015), Alternative Healthy Eating Index 2010 (AHEI-2010), Mediterranean Diet (MedDiet) and overweight/obesity in children and adolescents.

METHODS

This cross-sectional study used data of participants aged 2-19 years from National Health and Nutrition Examination Survey (NHANES) 2005-2018. The weighted logistic regression model was adopted to explore the association between diet quality scores and overweight, obesity in children and adolescents. Subgroup analysis was also performed based on sex.

RESULTS

A total of 9,724 participants were included in children group (2-11 years old), and 5,934 were adolescent group (12-19 years old). All participants were divided into based on the BMI-for-age: underweight and normal, overweight and obesity groups. After adjusting for age, race, poverty-income ratio, maternal smoking during pregnancy and total energy, HEI-2015 and MedDiet scores were related to the risk of overweight in children, and only MedDiet scores remained associated with a decreased risk of obesity in children. MedDiet scores were associated with a decreased risk of overweight, obesity in adolescents, respectively, after adjusting age, sex, race, poverty-income ratio, cotinine, total energy and physical activity. The similar results in male participants were also found.

CONCLUSION

Higher MedDiet scores were associated with lower the risk of overweight and obesity, respectively, particularly for male children and adolescents. The higher HEI-2015 scores were also related to the risk of overweight in children.

Association of Snacking Frequency, Size, and Energy Density with Weight Status among Preschool-Aged Children in the United States

BACKGROUND

Snacking (ie, eating between meals) is common among US preschool-aged children, but associations with weight status are unclear.

OBJECTIVE

This research evaluated associations of snack frequency, size, and energy density as well as the percent of daily energy from snacking with weight status and sociodemographic characteristics among US children aged 2 to 5 years.

DESIGN

Cross-sectional analysis of 2007-2018 National Health and Nutrition Examination Survey data using two, caregiver proxy, 24-hour dietary recalls.

PARTICIPANTS/SETTING

US children aged 2 to 5 years (n = 3,313) with at least one snack occasion over 2 days of intake.

MAIN OUTCOME MEASURES

Snacking parameters included frequency (number of occasions per day), size (kilocalories per occasion), and energy density (kilocalories per gram per occasion) as well as percent of daily energy from snacking.

STATISTICAL ANALYSES

Generalized linear regression models evaluated associations of snacking with child weight status (ie, normal weight and overweight/obesity), adjusting for survey weights, energy misreporting, mean meal size, and sociodemographic covariates.

RESULTS

Children with overweight/obesity consumed more frequent snacks (2.8 [0.06] vs 2.5 [0.03] snacks/day, respectively; P < 0.001), larger snacks (188 [4] vs 162 [23] kcal/occasion, respectively; P < 0.001), and a greater percent of daily energy from snacking (29.80% [1.00%] vs 26.09% [0.40%], respectively; P < 0.001) than children with normal weight. Mean snack frequency and size as well as percentage of daily energy from snacking varied with child age, gender, and head of household education. Associations of snacking with child race and ethnicity were less consistent.

CONCLUSIONS

These nationally representative findings provide evidence that the consumption of larger, more frequent snacks is associated with overweight/obesity among US children aged 2 to 5 years and snacking varies by sociodemographic characteristics.

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.

Resting metabolic rate, abdominal fat pad and liver metabolic gene expression in female rats provided a snacking diet from weaning to adulthood

Our female rat model with continuous, ad libitum access to snacks and chow from weaning to adulthood closely mimics human feeding behavior from childhood onwards. It causes weight gain, enlarged abdominal fat pads, reduced insulin sensitivity and leptin resistance without an increase in total caloric intake. Our current study investigated if this change in energy partitioning is due to a decrease in resting metabolic rate (RMR). In addition, we determined if carbohydrate and lipid metabolism changes in abdominal fat pads and liver. RMR, using indirect calorimetry, was determined in control and snacking rats every two weeks from Days 28-29 to Days 76-77. RMR decreased with age in both groups, but there was no difference between snacking and control rats at any age. At termination, abdominal fat pads (parametrial, retroperitoneal and mesenteric) and liver samples were collected for determination of gene expression for 21 genes involved in carbohydrate and lipid metabolism using RT-qPCR. Analysis of gene expression data showed a striking difference between metabolic profiles of control and snacking rats in abdominal fat pads and liver, with a distinct segregation of genes for both lipid and carbohydrate metabolism that correlated with an increase in body weight and fat pad weights. Genes involved in lipogenesis were upregulated in abdominal fat pads, while genes involved in adipogenesis, and lipid recycling were upregulated in the liver. In conclusion, snacking in addition to chow from weaning in female rats causes a repartitioning of energy that is not due to depressed RMR in snacking rats. Rather, snacking from weaning causes a shift in gene expression resulting in energy partitioning toward enhanced abdominal fat pad lipogenesis, and adipogenesis and lipid recycling in liver.

The Discovery of Data-Driven Temporal Dietary Patterns and a Validation of Their Description Using Energy and Time Cut-Offs

Data-driven temporal dietary patterning (TDP) methods were previously developed. The objectives were to create data-driven temporal dietary patterns and assess concurrent validity of energy and time cut-offs describing the data-driven TDPs by determining their relationships to BMI and waist circumference (WC). The first day 24-h dietary recall timing and amounts of energy for 17,915 U.S. adults of the National Health and Nutrition Examination Survey 2007−2016 were used to create clusters representing four TDPs using dynamic time warping and the kernel k-means clustering algorithm. Energy and time cut-offs were extracted from visualization of the data-derived TDPs and then applied to the data to find cut-off-derived TDPs. The strength of TDP relationships with BMI and WC were assessed using adjusted multivariate regression and compared. Both methods showed a cluster, representing a TDP with proportionally equivalent average energy consumed during three eating events/day, associated with significantly lower BMI and WC compared to the other three clusters that had one energy intake peak/day at 13:00, 18:00, and 19:00 (all p < 0.0001). Participant clusters of the methods were highly overlapped (>83%) and showed similar relationships with obesity. Data-driven TDP was validated using descriptive cut-offs and hold promise for obesity interventions and translation to dietary guidance.

Eating patterns in a nationwide sample of Japanese aged 1-79 years from MINNADE study: eating frequency, clock time for eating, time spent on eating and variability of eating patterns

OBJECTIVE

Although there is growing evidence suggesting that eating patterns are important determinants of health status, comprehensive information on patterning of eating behaviours is almost lacking. The aim of this cross-sectional study was to describe eating patterns in Japan.

DESIGN

Information on actual eating behaviours was collected using 2-d dietary record in each season over a year (total 8 d). Eating occasions were defined as any discrete intake occasion (with a discrete start clock time and name) except for eating occasions consisting of water only, which were excluded.

SETTING

Japan.

PARTICIPANTS

A nationwide sample of 4032 Japanese aged 1-79 years.

RESULTS

The mean value of eating frequency of meals (i.e. breakfast, lunch and dinner), snacks and total eating occasions was 2·94, 1·74 and 4·68 times/d, respectively. The mean clock time for the start of breakfast, lunch and dinner was 07.24, 12.29 and 19.15 h, respectively. The mean time spent consuming breakfast, lunch, dinner and snacks was 19, 25, 34 and 27 min/d, respectively. On average, variability (i.e. average of absolute difference from mean) of meal frequency was small compared with that of snack frequency and total eating frequency. Both mean variability of clock time for the start of eating (<1 h) and mean variability of time spent on meals (<10 min/d) were also small. Conversely, mean variability of time spent on snacks was large (>18 min/d).

CONCLUSION

The present findings serve as both a reference and an indication for future research on patterning of eating behaviours.

An extra virgin olive oil-enriched chocolate spread positively modulates insulin-resistance markers compared with a palm oil-enriched one in healthy young adults: A double-blind, cross-over, randomised controlled trial

AIMS

To investigate if extra virgin olive oil (EVOO) or palm oil enriched chocolate spreads consumption leads to different results in terms of plasma ceramides concentration, glucose and lipid metabolism, inflammatory markers and appetite regulation in young healthy subjects.

METHODS

In a 2-week, double-blind, cross-over, randomised controlled trial, 20 healthy, normal-weight subjects with a mean age of 24.2 years (SD: 1.2), consumed chocolate spread snacks (73% of energy [%E] from fat, 20% from carbohydrates and 7% from proteins), providing 570 Kcal/day added to an isocaloric diet. The chocolate spreads were identical, except for the type of fat: EVOO oil, rich in monounsaturated fatty acids (MUFAs), or palm oil, rich in Saturated Fatty Acids (SFAs).

RESULTS

EVOO-enriched chocolate spread consumption led to better circulating sphingolipids and glucose profile, with reduced plasma ceramide C16:0, ceramide C16:0/ceramide C22:0-ceramide C24:0 ratio and sphingomyelin C18:0 (P = 0.030, P= 0.032 and P = 0.042, respectively) compared to the palm oil-enriched chocolate spread diet. HOMA-IR and plasma insulin were lower, while the Quicki and the McAuley Index were higher after the EVOO diet compared to the palm oil diet (P = 0.046, P = 0.045, P = 0.018 and P = 0.039 respectively). Subjects maintained a stable weight throughout the study. No major significant changes in total cholesterol, triglycerides, HDL, inflammatory markers, and appetite-regulating hormones/visual analogue scale were observed between the groups.

CONCLUSIONS

Partially replacing SFAs with MUFAs in a chocolate-based snack as part of a short-term isocaloric diet in healthy individuals may limit SFAs detrimental effects on insulin sensitivity and decrease circulating harmful sphingolipids in young adults.

What is a "Snack"? Perspectives from Adolescents in Urban Communities

Snacking contributes significantly to U.S. adolescents' dietary intake and is a particularly significant eating occasion for urban adolescents, who have high amounts of food autonomy and access to corner stores. Consequently, research has focused on understanding and improving snacking among urban adolescents. However, the word "snack" possesses several definitions in the literature, leading to inconsistences in research efforts. As such, the aim of this study was to explore the definition of a snack among urban adolescents by conducting phone interviews with 30 adolescents from a Boys & Girls Club in New York City. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Overall, adolescents defined a snack as a small, unhealthy food item that can be quickly eaten to reduce hunger between meals. Future directions include using the definition of a snack that emerged from this study to improve subsequent adolescent snacking interventions.

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.

Nutritious mushroom protein crisp – healthy alternative to starchy snack

Abstract

Global salty snacks category had reached USD 137 billion in sales in 2018. Due to growing health concerns and awareness, consumers are looking for healthy snack choices by avoiding ingredients such as fat, sugar, cholesterol, and sodium and selecting baked and salt free multigrain chips. A sizable number of consumers are concerned about snack nutrition and look for quality ingredients and minimally processed foods called as “Good Health Snack (GHS)”. In this work, we present the development of method of producing and testing mushrooms protein crisps (MPC), a healthy alternative to conventional starchy snacks that are rich in protein, nutraceutical compounds, minerals, vitamin, dietary fiber, and immunity inducing beta-glucans. The methods of producing MPC with different seasoning and hydrolyzed protein, calorie, nutritional and chemical composition, consumer response, shelf life after packing and market analysis are described. These systematic studies will help to market potential of this product which is a healthy alternative to other calorie rich snacks sold in the market benefiting the consumers.

Graphical abstract

Snack Food Consumption across the Pune Transect in India: A Comparison of Dietary Behaviors Based on Consumer Characteristics and Locations

This study examines patterns of snack food consumption (SFC) in the rural-urban-slum transect (RUST) of a large city Pune and its precincts (population 10 million) in India. The transect structure aims to mimic a representative survey for the location capturing differences by age, gender, urbanicity, and socio-economic levels. Dietary data from 1405 individuals were used to describe snacking patterns and other food consumed at different frequencies; extent of physical activity; and Body Mass Index (BMI) and waist circumference of children, adolescents, and adults. Our results indicate high incidence of SFC across all population age groups, gender, socio-economic levels, and locations. A distinctive finding in relation to studies in high income countries is the prevalence of hunger snacking with 70% identifying hunger as the primary reason for SFC. Apart from hunger, particularly for adolescents, peer influence and social interactions played a significant role in SFC. Dietary behaviors of slum dwellers were characterized by three-quarters of them having SFC together with family members at home. SFC supplemented calories for low-income consumers and complemented calorie intake for high income ones. No significant association with BMI is possibly due to obesogenic SFC being likely offset by lower consumption of non-snack food and higher physical activity among poor and slum dwellers. Promoting awareness about diets and lifestyles, improving physical and economic access to healthier snacks and nutrient dense foods can improve diet quality in a large and heterogeneous population such as Pune.

Joint temporal dietary and physical activity patterns: associations with health status indicators and chronic diseases

BACKGROUND

Diet and physical activity (PA) are independent risk factors for obesity and chronic diseases including type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). The temporal sequence of these exposures may be used to create patterns with relations to health status indicators.

OBJECTIVES

The objectives were to create clusters of joint temporal dietary and PA patterns (JTDPAPs) and to determine their association with health status indicators including BMI, waist circumference (WC), fasting plasma glucose, glycated hemoglobin, triglycerides, HDL cholesterol, total cholesterol, blood pressure, and disease status including obesity, T2DM, and MetS in US adults.

METHODS

A 24-h dietary recall and random day of accelerometer data of 1836 participants from the cross-sectional NHANES 2003-2006 data were used to create JTDPAP clusters by constrained dynamic time warping, coupled with a kernel k-means clustering algorithm. Multivariate regression models determined associations between the 4 JTDPAP clusters and health and disease status indicators, controlling for potential confounders and adjusting for multiple comparisons.

RESULTS

A JTDPAP cluster with proportionally equivalent energy consumed at 2 main eating occasions reaching ≤1600 and ≤2200 kcal from 11:00 to 13:00 and from 17:00 to 20:00, respectively, and the highest PA counts among 4 clusters from 08:00 to 20:00, was associated with significantly lower BMI (P < 0.0001), WC (P = 0.0001), total cholesterol (P = 0.02), and odds of obesity (OR: 0.2; 95% CI: 0.1, 0.5) than a JTDPAP cluster with proportionally equivalent energy consumed reaching ≤1600 and ≤1800 kcal from 11:00 to 14:00 and from 17:00 to 21:00, respectively, and high PA counts from 09:00 to 12:00.

CONCLUSIONS

The joint temporally patterned sequence of diet and PA can be used to cluster individuals with meaningful associations to BMI, WC, total cholesterol, and obesity. Temporal patterns hold promise for future development of lifestyle patterns that integrate additional temporal and contextual activities.

Longitudinal Study on Relationships among Snack Energy Intake, Body Mass Index, and Nutrient Intake in Japanese Children Aged 6-7 Years

A longitudinal study was conducted to assess associations between snack energy intake and either body mass index (BMI) or nutrient intake in Japanese children. A baseline survey was conducted with 243 children aged 6-7 y, and follow-up was performed 4 y later. Finally, 189 subjects were selected for the analysis. Snack intakes were obtained from self-administered records by guardians. The daily habitual whole dietary intake and exercise/sleep hours were obtained by questionnaires during the follow-up. Subjects were grouped into three, as per snack energy intake tertiles at baseline. Differences and linear trends between the three groups were tested for the mean values of snack energy intake, BMI, and nutrient density, 4 y after the baseline survey. In follow-up, the snack energy intake (kcal) in females was significantly higher in the intermediate (335±35, p<0.01) and high (318±32, p<0.05) groups than in low group (196±25). There was no significant difference in follow-up BMI in the three groups. However, after adjustment of the baseline BMI, a significantly positive linear trend (p<0.05) was observed in the follow-up BMI in females. There was no significant difference in total energy intake per day. In contrast, a significantly negative linear trend (p<0.05) was observed among the three groups in dietary nutrient density of calcium and vitamin A in females. These results suggest that, in females, a higher intake of snacks may affect the daily dietary balance, resulting in a higher BMI and lower mineral and vitamin intakes.

Socioeconomic Disparities in Foods/Beverages and Nutrients Consumed by U.S. Adolescents When Snacking: National Health and Nutrition Examination Survey 2005-2018

Snacking contributes a significant portion of adolescents’ daily energy intake and is associated with poor overall diet and increased body mass index. Adolescents from low socioeconomic status (SES) households have poorer snacking behaviors than their higher-SES counterparts. However, it is unclear if the types of food/beverages and nutrients consumed during snacking differ by SES among adolescents. Therefore, this study examines SES disparities in the aforementioned snacking characteristics by analyzing the data of 7132 adolescents (12–19 years) from the National Health and Nutrition Examination Survey 2005–2018. Results reveal that adolescents from low-income households (poverty-to-income ratio (PIR) ≤ 1.3) have lower odds of consuming the food/beverage categories “Milk and Dairy” (aOR: 0.74; 95% CI: 0.58-0.95; p = 0.007) and “Fruits” (aOR: 0.62, 95% CI: 0.50–0.78; p = 0.001) as snacks and higher odds of consuming “Beverages” (aOR: 1.45; 95% CI: 1.19-1.76; p = 0.001) compared to those from high-income households (PIR > 3.5). Additionally, adolescents from low- and middle-income (PIR > 1.3–3.5) households consume more added sugar (7.98 and 7.78 g vs. 6.66 g; p = 0.012, p = 0.026) and less fiber (0.78 and 0.77 g vs. 0.84 g; p = 0.044, p = 0.019) from snacks compared to their high-income counterparts. Future research is necessary to understand factors that influence snacking among adolescents, and interventions are needed, especially for adolescents from low-SES communities.

Evaluation of Nutrition Intervention On Snack's Eating Habits and Anthropometric Status of College Students in Malang City

Background: Problems that arise in students based on the results of the 2016 study indicate that more than 80% of students like to eat unhealthy snacks such as packaging snacks, fried foods, instant noodles, and meatballs. Where snacks contain high energy, carbohydrates, protein, saturated fat, and salt. The excess energy and nutrients intake are related to increasing the metabolic incidence of syndromes and the main risk factors for cardiovascular disease.Objectives: This study aims to determine the effectiveness of giving nutritional interventions to eating habits and anthropometric status of college students in Malang.Methods: The quasi-experimental design with 31 participants from college students in Malang. Nutrition interventions provided in the form of education related to healthy snacks and assistance in making healthy snacks. The instruments used were pretest-posttest, questionnaire, and semi FFQ. Data processing was carried out by descriptive statistical analysis and dependent t-test at a 95% confidence level.Results: There was a significant increase in knowledge related to healthy snacks for subyek penelitiants (p <0.01) indicated by the results of the pre-test and post-test. There was an increase in the influence with nutrition claims by 31% and there was a significant difference between before and after the intervention (p = 0.013). The results of a healthy semi FFQ snack for the fruit category experienced a significant increase after being given an intervention program (p <0.01), while the semi FFQ results for unhealthy snacks for the category of salted crackers, chocolate/candy, pudding, and market snacks tended to decrease in consumption although not significant. The prevalence of overweight and obese in participants before being given intervention was 29% and decreased after being given intervention to 22.6% even though there was no significant difference (p = 0.096).Conclusions: There is an increase in the influence of 'nutrition claims' and fruit consumption significantly. While the prevalence of obese tends to fall even though it is not significant between college students.

Vegetable interventions at unconventional occasions: the effect of freely available snack vegetables at workplace meetings on consumption

Purpose

Snacks at work are often of poor dietary quality. The main objective of the current study is to examine the effect of making vegetable snacks available at workplace meetings on consumption.

Design/methodology/approach

In three between-subjects field experiments conducted at a hospital and three ministries in the Netherlands, with meeting as the unit of condition assignment, attendees were exposed to an assortment of vegetables, varying in vegetable variety and presence of promotional leaflet in study 1 (N = 136 meetings), serving container in study 2 (N = 88 meetings) and additional presence of cookies in study 3 (N = 88 meetings). Consumption of vegetables and cookies was measured at meeting level to assess grams consumed per person.

Findings

Across the three studies, average consumption per meeting attendee was 74 g (SD = 43) for study 1; 78 g (SD = 43) for study 2 and 87 g (SD = 35) for study 3. In the first study, manipulation of perceived variety and information leaflets did not affect intake. In the second study, significantly more vegetables were eaten when they were offered in single sized portions (M = 97 g, SD = 45) versus in a shared multiple portions bowl (63 g, SD = 38) (p < 0.001). In the third study, no effect was found of the additional availability of cookies on vegetable consumption during the meeting.

Practical implications

The present studies show how availability of vegetables at unconventional occasions makes meeting attendants consume considerable portions of vegetables on average. As such, offering healthy snacks at the workplace may be a valuable part of workplace health promotion programs and positively change the “office cake culture”.

Originality/value

Vegetable intake is less than recommended in many countries worldwide. Many snacking occasions are at work, which makes office meetings a potential consumption occasion to encourage vegetable intake. Hence, the aim of this study is to examine whether free availability of vegetable snacks during meetings contributes to their consumption among meeting attendees and under what conditions consumption is optimal.

Snacking patterns throughout the life span: potential implications on health

Eating outside the three main meals - in other words, snacking - is a part of the dietary pattern of individuals in all stages of life. The quality and pattern of snacking have an impact on health during the life span. Thus, the aim of this review was to evaluate various patterns and health outcomes of the snacking habits of different demographical groups, from children to the elderly, throughout their life span. We discuss the snacking pattern among children and adolescents, which is characterized by consuming high energy foods with low nutrient value, and which is associated with increased risk of obesity. During university years, study stress and lack of time were obstacles to a healthy dietary pattern involving nutritious snacks, although awareness of the importance of healthy snacks was higher in this group than among younger age groups. Employment status and skipping regular meals were important factors affecting snacking quality and patterns in adulthood. Unhealthy snacks, high in energy, sugar, and salt and low in nutrients, were demonstrated to have a negative impact on individuals' health, such as oral health, blood pressure, obesity, and diabetes. In conclusion, encouraging individuals to consume healthy snacks that are high in nutrients through education to help them plan for their snacks is important to enhance health and reduce disease risk.

Role of Dietary Factors, Food Habits, and Lifestyle in Childhood Obesity Development: A Position Paper From the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition

ABSTRACT

Childhood obesity has high societal and economic impact but current treatment approaches are sub-optimal. In the last decade, important studies have been conducted aiming to identify strategies to prevent obesity during critical periods of life. Updated recommendations for childhood obesity prevention are needed. We present data from systematic reviews and meta- analysis, randomised controlled trials (RCTs) and large observational studies, published from 2011 onwards that consider the possible role of the following factors in obesity development: breast-feeding; macronutrient composition and method of complementary feeding; parenting style; dietary patterns; sugar-sweetened beverage consumption; eating behaviour (eg, skipping breakfast, family dinners. etc); meal frequency and composition (fast foods, snacking), portion size; dietary modulators of gut microbiota (including pre-, pro-, and synbiotics); physical activity and sedentary behaviour. We used the Medline database and the Cochrane Library to search for relevant publications. Important research gaps were also identified. This position paper provides recommendations on dietary factors, food habits, and lifestyle to prevent childhood obesity development, based on the available literature and expert opinion. Clinical research and high-quality trials are urgently needed to resolve numerous areas of uncertainty.

Association of Dietary Patterns with Weight Status and Metabolic Risk Factors among Children and Adolescents

Unhealthy dietary patterns are associated with obesity in children and adolescents. However, few studies have investigated the relationships between dietary patterns and obesity-related metabolic disorders among Asians. We identified dietary patterns in children and adolescents and examined the associations between these patterns and obesity, insulin resistance, and metabolic syndrome in South Korea. This study is a cross-sectional design. We used baseline data from an intervention study of 435 Korean children and adolescents aged 6–17 years. Insulin resistance was assessed as HOMA-IR ≥ 2.6. Metabolic syndrome was diagnosed by cardiovascular disease risk factor clustering. Dietary intakes were estimated using 3-day food records. Factor analysis was used to obtain dietary patterns, and we examined the associations between dietary patterns and obesity-related markers adjusted for potential covariates. Three dietary patterns were identified as fast food and soda (FFS), white rice and kimchi (WRK), and oil and seasoned vegetable (OSV) patterns. Compared with participants in the lower intake of FFS pattern, those in the top intake were associated with a higher waist circumference (WC) (β = 1.55), insulin level (β = 1.25), and body mass index (BMI) (β = 0.53) and it was positively associated with HOMA-IR ≥ 2.6 (OR = 2.11; 95% CI: 1.227–3.638) (p < 0.05). WRK pattern was associated with lower weight and higher HDL cholesterol, and the OSV pattern was associated with a lower weight, WC, and insulin level (p < 0.05). The FFS pattern showed a positive relation with WC, serum insulin, and BMI, and the other two dietary patterns indicated a preventive effect of those parameters. The FFS pattern was associated with significantly elevated insulin resistance among children and adolescents.

The Association between Portion Sizes from High-Energy-Dense Foods and Body Composition in European Adolescents: The HELENA Study

Obesity prevalence has been simultaneously increasing with high consumption of large food portion sizes (PS). However, there is scarce information on PS of energy-dense (ED) foods as a potential risk factor of obesity in adolescents. In the present study, we investigate the association between the PS of the most ED foods and body composition. A sample of 1889 adolescents (54.4% females) from the Healthy Lifestyle in Europe by Nutrition in Adolescence cross-sectional multicenter study (HELENA-CSS) study were included. Most ED foods (e.g., cheese) were selected according to higher fat and/or sugar content and low fiber and water. Linear and ordinal logistic regression models were adjusted for age, physical activity, total energy intake (TEI), and socioeconomic status (SES). Analysis was performed both in those adolescents reporting plausible energy intake according to the approach of Goldberg et al. and in the whole sample. In male plausible reporters, PS from "breakfast cereals" showed a significant and positive association with BMI (β = 0.012; 0.048). PS from "carbonated soft drinks" in males (OR = 1.001; 95% CI 1.000; 1.002) and "bread and rolls" in females (OR = 1.002; 95% CI 1.000; 1.004) were associated with higher probability of having obesity, while "sweet bakery products" were associated with lower probability of having obesity (OR = 0.996; 95% CI 0.991; 0.999) in females. The present study suggests association between PS of ED foods and obesity in European adolescents. Prospective studies are needed to examine the effect of prolonged exposure to large PS and obesity development.

Prevalence and associated factors of abdominal obesity among the adult population in Woldia town, Northeast Ethiopia, 2020: Community-based cross-sectional study

BACKGROUND

The prevalence of abdominal obesity has been dramatically increasing both in developed and developing countries, including Ethiopia. It is an independent risk factor for cardiovascular diseases, type-2 diabetes mellitus, high blood pressure, and cancer. However, there is inadequate data regarding the prevalence and associated factors of abdominal obesity among adult population in Ethiopia.

OBJECTIVE

This study aimed to assess the prevalence and associated factors of abdominal obesity among the adult population in Woldia town, Northeast Ethiopia in 2020.

METHOD

A community-based cross-sectional study was conducted in Woldia town from March 20 to April 20, 2020. Data on socio-demographic, dietary history, and anthropometric characteristics were collected from 802 adults using the World Health Organization stepwise technique. Multi-stage sampling was employed to select the study subjects. Data were cleaned, coded, and entered by EPI-info Version 7 and were exported to SPSS Version 20 for further analysis. To indicate the strength of association, odds ratios (OR) and 95% confidence intervals (95% CI) were used.

RESULT

From a total of 823 respondents 802 were involved with a response rate of 97.4%. The overall prevalence of central obesity based on waist to hip ratio was 16.5% with 95% CI (14.2-19.2). Female sex [AOR = 13.3, 95% CI: 7.01-25.39), high wealth rank (AOR = 2.95, 95% CI: 1.21-7.17), single marital status (AOR = 0.16, 95%CI: 0.04-0.58), age from 35 to 55 years (AOR = 4.3, 95% CI: 2.22-7.99), age greater than 55 years (AOR = 3.8, 95%CI: 1.36-10.78), secondary educational level (AOR = 1.83, 95% CI: 1.05-3.18), eat more protein (AOR = 4.22, 95% CI: 1.26-14.22), and consumption of snacks (AOR = 2.78, 95% CI: 1.68-4.61) were significantly associated with abdominal obesity.

CONCLUSION

The prevalence of abdominal obesity among adults in Woldia town is high, and has become an emerging nutrition-related problem. Being female, older age, being in a high wealth rank, consuming more meat, having secondary education level, and consuming snacks were the risk factors of abdominal obesity. Nutrition interventions should target adults mainly focusing on the alarmingly increase in nutrition problems, such as abdominal obesity, in Ethiopia with specific attention to females.

Association of Usual Sodium Intake with Obesity Among US Children and Adolescents, NHANES 2009-2016

OBJECTIVE

The purpose of this study was to investigate the association of sodium intake with obesity in US children and adolescents.

METHODS

Cross-sectional data were analyzed for 9,026 children and adolescents in the National Health and Nutrition Examination Survey (NHANES) 2009-2016. Usual sodium intake was estimated from 24-hour dietary recalls using a measurement error model. Logistic regression was used to assess the association of sodium intake with overweight/obesity, obesity, and central obesity (waist to height ratio [WtHR] ≥ 0.5; waist circumferences (WC) ≥ age- and sex-specific 90th percentile).

RESULTS

Mean (SE) sodium intake was 3,010  (9) and 3,404  (20) mg/d for children and adolescents, respectively. The adjusted odds ratio (AOR) comparing Q4 versus Q1 (87.5th vs. 12.5th percentile of sodium intake) among children was 1.98 (95% CI: 1.19-3.28) for overweight/obesity, 2.20 (1.30-3.73) for obesity, 2.10 (1.12-3.95) for WC ≥ 90th percentile, and 1.68 (0.95-2.97) for WtHR ≥ 0.5, adjusting for demographics, energy, and sugar-sweetened beverage intake. Among adolescents, AOR was 1.81 (0.98-3.37) for overweight/obesity, 1.71 (0.82-3.56) for obesity, 1.62 (0.71-3.66) for WC ≥ 90th percentile, and 1.73 (0.85-3.50) for WtHR ≥ 0.5.

CONCLUSIONS

Sodium intake was positively associated with overweight/obesity, obesity, and central obesity among US children independent of energy and SSB intake, but the association did not reach significance among adolescents.

Aligning nutrition knowledge and dietary habits of generation Z: Is there a room for improvement?

The potential association between determinants such as nutrition knowledge and dietary habits with obesity development among adolescents of generation Z (Zoomers) was investigated in the presented study. Data regarding meals consumption frequency, snack choice and familiarity with amounts of basic food nutrients in diet were gathered throughout a self-designed questionnaire from 854 adolescents (11-18 years) attending elementary and secondary schools in the Autonomous Province of Vojvodina, Serbia. The corresponding data was analysed and discussed primarily concerning BMI-forage , and subsequently, gender and educational stage. The association between BMI categories and examined determinants was tested using chi-square and multinomial logistic regression statistics. Although most of the surveyed adolescents had normal weight (72.1%), a notable share of overweight adolescents was also detected (17.9%). Additionally, observed irregularities in breakfast and dinner consumption frequencies and participants' modest nutrition knowledge can contribute to further diet deterioration. Statistically significant but weak associations between BMI-forage and choice of snack, dinner consumption frequency, as well as the frequency of salty snack and fast food consumption, were noted. Furthermore, an increase in nutrition knowledge was inversely associated with obesity prevalence (OR 6.56, 95% CI 1.388-31.037). As an outcome, the need for improvement regarding studied determinants especially nutrition knowledge is established and represents a task to achieve through health promotion strategies among generation Z.

Temporal Dietary Patterns Are Associated with Obesity in US Adults

BACKGROUND

The integration of time with dietary patterns throughout a day, or temporal dietary patterns (TDPs), have been linked with dietary quality but relations to health are unknown.

OBJECTIVE

The association between TDPs and selected health status indicators and obesity, type 2 diabetes (T2D), and metabolic syndrome (MetS) was determined.

METHODS

The first-day 24-h dietary recall from 1627 nonpregnant US adult participants aged 20-65 y from the NHANES 2003-2006 was used to determine timing, amount of energy intake, and sequence of eating occasions (EOs). Modified dynamic time warping (MDTW) and kernel k-means algorithm clustered participants into 4 groups representing distinct TDPs. Multivariate regression models determined associations between TDPs and health status, controlling for potential confounders, and adjusting for the survey design and multiple comparisons (P <0.05/6).

RESULTS

A cluster representing a TDP with evenly spaced, energy balanced EOs reaching ≤1200 kcal between 06:00 to 10:00, 12:00 to 15:00, and 18:00 to 22:00, had statistically significant and clinically meaningful lower mean BMI (P <0.0001), waist circumference (WC) (P <0.0001), and 75% lower odds of obesity compared with 3 other clusters representing patterns with much higher peaks of energy: 1000-2400 kcal between 15:00 and 18:00 (OR: 5.3; 95% CI: 2.8, 10.1), 800-2400 kcal between 11:00 and 15:00 (OR: 4.4; 95% CI: 2.5, 7.9), and 1000-2600 kcal between 18:00 and 23:00 (OR: 6.7; 95% CI: 3.9, 11.6).

CONCLUSIONS

Individuals with a TDP characterized by evenly spaced, energy balanced EOs had significantly lower mean BMI, WC, and odds of obesity compared with the other patterns with higher energy intake peaks at different times throughout the day, providing evidence that incorporating time with other aspects of a dietary pattern may be important to health status.

Magnitude of Overweight, Obesity and Insufficient Physical Sports Activities Among Secondary School Students in Kinondoni Municipal, Dar es Salaam

INTRODUCTION

There is an overwhelming increase of Non-Communicable Disease worldwide such as diabetes and cardiovascular diseases. Overweight and obesity are highly associated with development of these diseases. Unhealthy lifestyle such as excessive sugar, alcohol intake and lack of adequate physical activities has been associated with development of obesity. However, these risk factors are not well elucidated among adolescents in Tanzania. We conducted this survey to determine obesity, overweight, self-reported physical activities, and preferred foods among secondary school students in Kinondoni Municipal in Dar es salaam, Tanzania.

METHODS

A cross sectional descriptive survey was conducted among secondary school students at Kambangwa and Makumbusho secondary schools in Kinondoni municipal in Dar es Salaam city. A simple random sampling technique was used to select participating schools with systemic random selection procedure was used to select participants. A pre structured, self-administered questionnaire was used to collect demographic information from the participants. Anthropometric measurement for Body Mass Index (BMI) was done using standard tools. Interpretation of the findings was done using World Health Organization (WHO) standard charts for age and sex. Data were analysed using Statistical Package for Social Sciences (SPSS version 20; SPSS Inc., Chicago, US).

RESULTS

A total of 234 participants were enrolled in the study. A total of 204 (87.2%) of study participants reported to regularly participate in physical sports activities. Furthermore, Males reported to participate more in physical sports activities compared to females (χ2 (1) =8.13., p = 0.004). During sex-wise comparison, 30 (46.2%) of males reported to participate in sports once per week compared to 71 (51.5%) of females. Reported frequency was influenced by participants' sex (χ2 (3) =16.4., p= 0.001). A total of 28 (12%) participants reported fruits as their favourite food. Food preference was influenced by the participants' sex (X 2 (5) =13.1., p < 0.02). 32(47.7%) of males reported fresh fruits juice as their favourite drink compared to 106(63.5%) of females) while 6(9%) of males reported to prefer commercial industrial juice compared to 4 (2.4%) of females.

CONCLUSION

Obesity and overweight are prevalent among secondary school adolescents in Kinondoni Municipal, Dar es salaam. In addition, the magnitude of physical activities was below the recommended amount. Therefore, awareness campaigns and advocacy programs aiming at preventive measures against NCDs such as healthy eating behaviour and promotion of physical activities among adolescents should be given high priority.

Night-restricted feeding improves locomotor activity rhythm and modulates nutrient utilization to accelerate growth in rabbits

An unfavorable lifestyle disrupts the circadian rhythm, leading to metabolic dysfunction in adult humans and animals. Increasing evidence suggests that night-restricted feeding (NRF) can effectively prevent ectopic fat deposition caused by circadian rhythm disruption, and reduce the risk of metabolic diseases. However, previous studies have mainly focused on the prevention of obesity in adults by regulating dietary patterns, whereas limited attention has been paid to the effect of NRF on metabolism during growth and development. Here, we used weaning rabbits as models and found that NRF increased body weight gain without increasing feed intake, and promoted insulin-mediated protein synthesis through the mTOR/S6K pathway and muscle formation by upregulating MYOG. NRF improved the circadian clock, promoted PDH-regulated glycolysis and CPT1B-regulated fatty-acid β-oxidation, and reduced fat content in the serum and muscles. In addition, NRF-induced body temperature oscillation might be partly responsible for the improvement in the circadian clock and insulin sensitivity. Time-restricted feeding could be used as a nondrug intervention to prevent obesity and accelerate growth in adolescents.

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.

Using methylome data to inform exposome-health association studies: An application to the identification of environmental drivers of child body mass index

BACKGROUND

The exposome is defined as encompassing all environmental exposures one undergoes from conception onwards. Challenges of the application of this concept to environmental-health association studies include a possibly high false-positive rate.

OBJECTIVES

We aimed to reduce the dimension of the exposome using information from DNA methylation as a way to more efficiently characterize the relation between exposome and child body mass index (BMI).

METHODS

Among 1,173 mother-child pairs from HELIX cohort, 216 exposures ("whole exposome") were characterized. BMI and DNA methylation from immune cells of peripheral blood were assessed in children at age 6-10 years. A priori reduction of the methylome to preselect BMI-relevant CpGs was performed using biological pathways. We then implemented a tailored Meet-in-the-Middle approach to identify from these CpGs candidate mediators in the exposome-BMI association, using univariate linear regression models corrected for multiple testing: this allowed to point out exposures most likely to be associated with BMI ("reduced exposome"). Associations of this reduced exposome with BMI were finally tested. The approach was compared to an agnostic exposome-wide association study (ExWAS) ignoring the methylome.

RESULTS

Among the 2284 preselected CpGs (0.6% of the assessed CpGs), 62 were associated with BMI. Four factors (3 postnatal and 1 prenatal) of the exposome were associated with at least one of these CpGs, among which postnatal blood level of copper and PFOS were directly associated with BMI, with respectively positive and negative estimated effects. The agnostic ExWAS identified 18 additional postnatal exposures, including many persistent pollutants, generally unexpectedly associated with decreased BMI.

DISCUSSION

Our approach incorporating a priori information identified fewer significant associations than an agnostic approach. We hypothesize that this smaller number corresponds to a higher specificity (and possibly lower sensitivity), compared to the agnostic approach. Indeed, the latter cannot distinguish causal relations from reverse causation, e.g. for persistent compounds stored in fat, whose circulating level is influenced by BMI.

Nutritional behavior in Italian and immigrant children

BACKGROUND

There are 1.2 million of immigrant children living in Italy. However, data on their nutritional habits are limited. The aim of this study was to assess the nutritional profile in a cohort of both Italian and immigrant children.

METHODS

The study included 86 children aged 5-15 consecutively enrolled from January 2016 to May 2017 within a larger epidemiological study on determinants of diabetes. Immigrant state was defined on the basis of the parent origin. Data on nutritional profile, frequency of food group consumption, and eating habits were collected using the 24-hour dietary recall method and a questionnaire. Anthropometric parameters were measured.

RESULTS

In the cohort of immigrant children there was a higher prevalence of both overweight (27.3 vs. 14.1%) and obesity (18.2 vs. 3.1%) subjects and a greater total calorie intake compared to Italian children, mainly due to excess simple carbohydrate intake. Immigrant children had a higher consumption of sweets, snacks, and drinks with added sugar. Moreover, unhealthy habits, such as eating alone and eating while watching TV, were more frequent among immigrant children.

CONCLUSIONS

In this cohort, immigrant children had a higher prevalence of overweight/obesity possibly due to less healthy nutritional habits. Culturally-tailored nutritional interventions may help preventing the development of obesity-related diseases in this population.

Relationships Among Parental Psychological Distress, Parental Feeding Practices, Child Diet, and Child Body Mass Index

BACKGROUND

Parents often play a main role in establishing the dietary patterns of preschool children, but there is no clear understanding about the relationship between parental psychological distress and child diet and body mass index (BMI).

OBJECTIVE

The aim of this study was to examine the relationships among parental psychological distress, parental feeding practices, child diet, and child BMI in families with young children.

METHODS

We conducted a mixed-methods study with families (parent-child dyad) of children aged 2-5 years. Measures included demographic data, parental general stress, parenting stress, parental sleep quality, parental depressive symptoms, social support for parents, mealtime environment, child feeding practice, child diet, and child BMI, with well-validated questionnaires completed by parents. Using structural equation models, we examined the path relationships of these factors. We also interviewed a subsample of 13 parents.

RESULTS

A total of 256 families participated. Higher parental psychological distress was associated with higher parental unhealthy feeding practices (B = 0.31, p < .01). However, a parental unhealthy practice in feeding was not associated with child's unhealthy diet or BMI. There was no direct relationship between parental psychological distress and child BMI. Social support for parents was significantly inversely related to parental psychological distress (B = -11.59, p < .01), and the relationship between social support for parents and parental unhealthy feeding practices approached significance (B = 6.11, p = .05). A main theme from analysis of parent interview was that parent stress and fatigue influenced their feeding and food preparation.

DISCUSSION

Parental psychological distress is a critical influential factor in parental feeding practices. This finding highlights potential foci in intervention programs to address parental psychological distress.

Dietary Guidelines Are Not Met by In-Home Child Care Providers in Low-Income Areas

OBJECTIVE

The goals of this study were to describe (1) the dietary quality of foods and beverages served by in-home child care providers in low-income areas in Michigan and (2) the extent to which they align with the Dietary Reference Intakes and food group recommendations.

DESIGN

Cross-sectional, observational. Food and beverages served were examined using direct diet observation.

SETTING

Child care provider homes.

PARTICIPANTS

In-home child care providers (n = 116) from rural and urban Michigan counties (n = 24) were recruited from the Great Start to Quality child care database.

MAIN OUTCOME MEASURES

Dietary quality (food groups and nutrients) of food and beverages served by 116 providers to 378 children, aged 2-5 years, for 1 lunch and a snack.

ANALYSIS

Average food group and nutrient scores were compared with Dietary Reference Intakes and food group thresholds using the Wilcoxon rank sum test (significance at <.05).

RESULTS

Findings indicate overserving of refined grains, protein, carbohydrates, added sugars, and sodium and underserving of whole grains and vegetables. Nutrients exceeding recommendations included vitamins A, C, and D, folate, calcium, zinc, and magnesium, whereas iron and potassium were underserved.

CONCLUSIONS AND IMPLICATIONS

Tailored efforts are needed to address shortcomings in meeting dietary recommendations among in-home child care providers to enhance child nutrition.

Prevalence and Predictors of Obesity among 7- to 17-Year-Old Schoolchildren in Urban Arusha, Tanzania

Background

Childhood obesity is currently increasing at an alarming rate worldwide. Childhood obesity research has not been reported in urban Arusha before. This is therefore the first study to investigate the prevalence and predictors of childhood obesity in urban Arusha.

Methods

A cross-sectional study was conducted involving 451 schoolchildren. Overweight was defined to range from 85^th to 94^th BMI percentile for age and sex while obesity was defined as above 94^th BMI percentile for age and sex. Chi-square test was used for comparison between child sex and sociobehaviors, and multiple logistic regression was used to determine the significant predictor factors at P values = 0.05.

Results

The overall prevalence of overweight and obesity was 17.7% (80/451) with 12.6% (57/451) being obese and 5.1% (23/451) being overweight. Results from univariate logistic regression showed child sex, random sleeping time, and random eating habit were the significant predictor factors. However, when all the predictor factors were used in the final multiple logistic regression model, only random sleeping time and random eating habit of different food items irrespective of their nature were significant at P=0.000, AOR = 4.47, and 95% CI = 2.00–10.01, and P=0.012, AOR = 2.54, and 95% CI = 1.23–5.33, respectively.

Conclusions

The prevalence of obesity was as higher as twice the prevalence observed in other previous studies in Tanzania. Being a girl, random sleeping time and random eating habit were independent predictors. In addition to larger sample sizes, longitudinal studies are needed in order to track individuals and population level trends in BMI over time.

Association between dietary diversity and obesity in Ardebil adults: a case-control study

Purpose

Obesity is a multi-factorial problem that develops from an interaction between diet, genetics, physical activity, medication, and other factors. This paper aims to examine the association between dietary diversity score (DDS) and obesity among adults of Ardebil.

Design/methodology/approach

This case-control study was conducted on 204 cases (obese and overweight participants) and 204 controls (healthy weight individuals) matched by socioeconomic status (SES), age (older than 30 years) and sex. Dietary intake was assessed using a 24 h food recall questionnaire. Data on physical activity and socio-demographic variables were gathered. DDS was computed based on the scoring of the 14 food groups recommended by the Food and Agriculture organization guideline.

Findings

The DDS of the obese group was higher (5.02 ± 1.02) than that of the healthy weight group (4.23 ± 1.18) (p < 0.001). There was a significant association between DDS and body mass index (BMI) in both groups of study, but this association was more significant in the obese group (β= 0.501,p = 0.021) than that of healthy weight group (β= 0.413,p= 0.042). Vegetable food group score in both groups of the study was associated with obesity inversely (p < 0.05).

Originality/value

This study was conducted for the first time in Ardabil city and the results showed for the first time that there is a relationship between dietary diversity and obesity. People with a higher dietary diversity score are more likely to be obese. In fact, this study for the first time proved that people who are obese have a more varied diet but less vegetables and fruits.

Snacking frequency and dietary intake in toddlers and preschool children

Understanding the relationship between snacking and dietary intake in early life years is one key but understudied area. In this study, we examined snacking patterns in toddlers and preschool children and the associations between snacking frequency and daily energy intake. We analyzed data from children aged 12-72 months (N = 1186) in the Newborn Epigenetic STudy (NEST). We used Bonferroni multiple comparison methods to examine the differences in snacking patterns across subgroups. Linear and quantile regression models were fit to investigate the association between dietary intake and snacking frequency. Our estimates suggest that Non-Hispanic blacks had the highest total daily energy intake from snacks (334 kcal/day) compared to non-Hispanic whites (270 kcal/day) and Hispanics (274 kcal/day) in 12-to-24-month-olds. In 2-to-6-year-olds, mean energy intake from snacks was 296 kcal/day without a significant racial/ethnic difference. Carbohydrate, fat and protein from snacks contributed about 17%, 9% and 4% respectively of the total energy intake in 12-to-24-month-olds while they contributed about 15%, 7% and 2% respectively of the total energy intake in the other age group. Snacking frequency was positively and significantly associated with total daily energy intake in both 12-to-24-month-olds and 2-to-6-year-olds as indicated by regression coefficient estimates of snacking frequency (β = 31.3 kcal/day with P = 0.027 and β = 175.4 kcal/day with P < 0.0001, respectively, indicating a higher snacking frequency was associated with a greater total daily energy intake). In conclusion, snacking frequency was positively associated with daily energy intake. Carbohydrates and fats from snacks are significant energy contributors. Age differentiation was apparent regarding the relationship between snacking frequency and dietary intake. Differentiated interventions that are age-specific and focus on the dietary quality of snacks instead of quantity are needed.

Allelic Variation in Taste Genes Is Associated with Taste and Diet Preferences and Dental Caries

Taste and diet preferences are complex and influenced by both environmental and host traits while affecting both food selection and associated health outcomes. The present study genotyped 94 single nucleotide polymorphisms (SNPs) in previously reported taste and food intake related genes and assessed associations with taste threshold (TT) and preferred intensity (PT) of sweet, sour and bitter, food preferences, habitual diet intake, and caries status in healthy young Swedish men and women (n = 127). Polymorphisms in the GNAT3, SLC2A4, TAS1R1 and TAS1R2 genes were associated with variation in TT and PT for sweet taste as well as sweet food intake. Increasing PT for sweet was associated with increasing preference and intake of sugary foods. Similarly, increasing TT for sour was associated with increasing intake of sour foods, whereas the associations between food preference/intake and TT/PT for bitter was weak in this study group. Finally, allelic variation in the GNAT3, SLC2A2, SLC2A4, TAS1R1 and TAS1R2 genes was associated with caries status, whereas TT, PT and food preferences were not. It was concluded that variations in taste receptor, glucose transporter and gustducin encoding genes are related to taste perception, food preference and intake as well as the sugar-dependent caries disease.

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.

Beyond Meat: A Comparison of the Dietary Intakes of Vegetarian and Non-vegetarian Adolescents

Dietary intake of adult vegetarians from large prospective studies has been well-characterized but is rarely reported in vegetarian adolescents. Our objective was to describe and compare the dietary intake of vegetarian adolescents with their non-vegetarian counterparts in a population known to espouse healthy living. Adolescents (n = 534) aged 12–18 years old from middle and high schools near major Adventist universities in Michigan and Southern California provided dietary, demographic, and anthropometric data. Dietary intake was measured with a validated 151-item self-administered web-based food frequency questionnaire; weight and height were measured during school visits. Vegetarian was defined as the combined intake of meat, meat derivatives, poultry, and fish of <1 serving per week. Descriptive statistics and ANCOVA were used to compare the intake of vegetarians and non-vegetarians. Vegetarians significantly ate more fruits, vegetables, and other plant-based foods, but significantly less foods of animal origin, sugar-sweetened beverages, and coffee/tea compared to non-vegetarians. Vegetarians had significantly higher intakes of carbohydrates and total protein but lower intakes of fats, animal protein, and zinc compared to their counterparts. A majority (75% or more) of both groups met the 2015 Dietary Guidelines' age-and-gender-specific recommendations for most nutrients but only 16–18% of vegetarians/non-vegetarians did not exceed the upper limit for sodium. More vegetarians (49%) than non-vegetarians (25%) had <10% of their caloric intake from SFA. More than 90% of both groups met dairy recommendations, but greater proportions of vegetarians met recommendations for vegetables, fruits, nuts/soy products, and legumes than non-vegetarians. Of the non-vegetarians, only 7% and 44% met the fish and meats/poultry/eggs recommendation, respectively, which none of the vegetarians met. Compared to the general US adolescent population, both diet groups ate more fruits, vegetables, dairy and protein foods, and also consumed more micronutrients but less macronutrients. Overall, vegetarian adolescents have a more favorable dietary intake profile than non-vegetarians, but both vegetarians and non-vegetarians in this study population have a more adequate diet than the general US adolescent population. The influence of the Adventist plant-based diet culture that is translated both at home and at school is evident in our findings.

Long-term effect of feeding snacks at age 6 years on body mass index at ages 12 and 22 years

We investigated the effect of snacking habits in childhood on changes in body mass index (BMI) and high BMI in adolescence and adulthood. In total, 2141 Japanese children from the Ibaraki Children's Cohort Study were evaluated at age 6 years (baseline), then at ages 12 and 22 years. We examined associations between snacking (scheduled times, when children wanted, and freely) at age 6 years and changes in BMI over time and the proportion of high BMI at ages 12 and 22 years, using time-dependent mixed-effects and logistic regression models. Compared with children who snacked at scheduled times, those provided snacks when they wanted experienced larger increases in BMI over time between ages 6 and 22 years (multivariable time-dependent effect: 0.03 kg/m² for boys, p = 0.047; 0.04 kg/m² for girls, p = 0.019). No differences were observed in children who snacked freely. A higher proportion of high BMI was found in boys who were provided snacks when they wanted compared with those who snacked at scheduled times. The multivariable odds ratio (95% confidence interval) was 1.52 (1.04-2.23) at age 12 years and 2.23 (1.12-4.45) at age 22 years. No differences were observed for girls at either age. Children who were provided snacks when they wanted showed larger increases in BMI over time compared with those who snacked at scheduled times. Boys who were provided snacks when they wanted showed the higher proportion of high BMI at follow-up.

Snack Consumption Patterns among Canadians

The snacking prevalence, frequency of daily snack consumption, and the contribution of snacks to daily energy intake have substantially increased globally. The aim of this study was to examine the patterns of snack consumption among a representative sample of Canadians aged 2 and older. Nationally representative dietary data from the Canadian Community Health Survey (CCHS) conducted in 2015 (n = 19,677 participants aged ≥2 years) were used to describe snacking patterns. In all, 80.4% of Canadians reported consuming at least one snack per day, which varied between different age groups from 77.0% (≥55 years) to 96.4% (2–5 years). About 37% of snack consumers reported only one snack episode per day but nearly 10% reported four or more episodes of snacking. Snacking contributed to nearly 23% of total daily energy intake in Canadians, which was highest among younger children (27%) and lowest among older adults (20.8%). There were no significant differences in obesity measures comparing snack consumers and non-consumers in children and adults. Snacking considerably contributes to total nutrient and energy intake of Canadians. Promoting nutrient-dense snacks provides an opportunity to improve overall diet quality.