Impact of snacking pattern on overweight and obesity risk in a cohort of 11- to 13-year-old adolescents

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.

Effects of a health versus hedonic mindset on daily-life snacking behaviour

BACKGROUND

In today's obesogenic environment high-caloric palatable foods are omnipresent, making it hard for many to reach and maintain a healthy body weight. This study investigates the effects of a health versus hedonic mindset on daily-life snacking behaviour. The hypothesis is that a health mindset leads to reduced snacking behaviour compared to a hedonic mindset. This effect is expected to be most pronounced with high dietary restraint and least pronounced with high trait self-control.

METHODS

For 3 weeks, degree of craving and amount of snacks that were craved and consumed were assessed four times a day, using smartphone Ecological Momentary Assessment (EMA). A total of 111 female participants (body mass index range: 20-23.5) were randomly assigned to a 1-week health (n = 53) or hedonic (n = 58) mindset, occurring in week 2 of the EMA protocol. The mindset manipulations consisted of text messages, focusing either on the enjoyment of tasty food (hedonic) or on healthy living and eating (health).

RESULTS

contrary to our hypotheses, mindset did not affect snacking behaviour. Instead, degree of craving and intake of snacks reduced significantly over time, not moderated by mindset, dietary restraint (Restraint Scale) or trait self-control (Brief Self-Control Scale). Importantly, this was not due to reduced compliance. Possibly, the reduced craving and snacking behaviour were due to monitoring and/or socially desirable answering tendencies. Additional time point analyses showed that craving was strongest in the late afternoon (3:30-5:00 PM), and-across mindset conditions-degree of craving correlated negatively with trait self-control.

CONCLUSIONS

future studies could manipulate degree of monitoring and design individually tailored manipulations.

Association of malnutrition and main-meal- and snack-predominant intake among female adolescent students in boarding schools in Tasikmalaya, Indonesia

Background: Balanced dietary intake is needed to prevent malnutrition which is one of the nutritional problems faced by adolescents. Aim: To study the association between predominant dietary intake and nutritional status of female adolescent students in boarding schools in Tasikmalaya, Indonesia. Method: This cross-sectional study was conducted on 323 female adolescent students residing full-time in eight boarding schools in Tasikmalaya, West Java. Students' dietary intake was measured using the 3-non-consecutive-day 24-h recall method. The association between the predominant dietary intake and nutritional status was evaluated using binary logistic regression. Results: Of the 323 students, 59 (18.3%) were overweight/obese (OW/OB) and 102 (31.6%) had stunted growth. The predominant dietary intake in the OW/OB group was snacks, whereas, in the stunted group, it was main meals. Snack-predominant dietary intake was a risk factor for overweight and obesity (p  =  0.008; adjusted odds ratio [AOR]: 2.276; 95% confidence interval [CI]: 1.244-4.164), but it was a protective factor against stunting (p  =  0.008; AOR: 0.521; 95% CI: 0.322-0.842). Conclusion: The predominance of main meals and snacks as components of total dietary intake affected the nutritional status of female adolescent students living in boarding schools. Therefore, the dietary intake interventions should tailor and design the nutritional contents of main meals and snacks according to the nutritional status of the targeted individuals.

Snacking behaviour and nutrients intake among 11-16 years-old students from two different boarding system schools

This study's main objective was to investigate the difference between snacking behaviors and dietary nutrient intake in boarding system students. A cross-sectional study was conducted at Beijing's closed and semi closed boarding management school. The snack consumption questionnaire collected snack consumption behaviors; three-day recall periods for food consumption data were collected through the canteen weighing method and 24-h dietary recall of students' intakes. For closed and semi closed boarding management schools, the percentage of never having snacking behaviors was 12.95% and 2.69% on weekdays and 2.16% and 4.19% on weekends. A higher proportion of respondents chose unhealthy snacks in closed boarding management schools. The main problems in closed boarding management schools were the excessively low percentage of energy from carbohydrates and the excessively high percentage of energy from fat. Both deficiency and excess energy supply ratios of protein, carbohydrate, and fat were present in semi-closed boarding management schools. There was a high risk of calcium, iron, zinc, magnesium, and selenium deficiency for most students in both management schools. The closed-school girls had the highest risk of suffering from iron deficiency. Vitamin A, vitamin B1, vitamin B2, vitamin C, and vitamin E deficiencies were severe in both schools, especially vitamin C, vitamin A, and vitamin B2 deficiencies in semi-closed boarding management schoolboys. Effective nutritional interventions should be taken to improve the nutritional status of both boarding management and school students.

Circadian clock and temporal meal pattern

The central circadian clock in the brain controls the time-of-the-day variations in acute meal responses, with a low glycemic response but a high satiety/thermogenic response to meals consumed at waking compared to other time points. Consistently, studies show that consuming a significant proportion of calories, particularly carbohydrates, in breakfast is beneficial for the chronic management of obesity and its associated metabolic syndrome, compared to consuming identical meals at dinner. Conversely, breakfast skipping or/and late dinner can have unfavorable metabolic outcomes. It remains controversial how meal frequency affects metabolic health. In contrast, irregular meals, especially irregular breakfasts, show consistent adverse metabolic consequences. Time-restricted feeding (TRF), with all calories consumed within less than 12-h per day, can improve metabolism and extend lifespan. A major component of TRF in humans is caloric restriction, which contributes significantly to the beneficial effects of TRF in humans. By comparison, TRF effects in rodents can be independent of caloric restriction and show day/night phase specificity. TRF could alleviate metabolic abnormalities due to circadian disruption, but its effects appear independent of the circadian clock in rodents. Understanding neuroendocrine mechanisms underlying clock-mediated metabolic regulation will shed light on the metabolic effects of temporal meal patterns.

The Influence of Increased Dairy Product Consumption, as Part of a Lifestyle Modification Intervention, on Diet Quality and Eating Patterns in Female Adolescents with Overweight/Obesity

Our study examined how increased dairy consumption versus habitually low dairy consumption, against a background of healthy eating (and exercise), influenced diet quality, nutrient intake, and snacking in Canadian female adolescents (14.8 ± 2.2 years) with overweight/obesity (OW/OB). We also explored dairy consumption patterns in the group consuming dairy products. Participants were randomized into two groups: higher/recommended dairy (RDa; 4 svg/d; n = 24) or low dairy (LDa; 0−2 svg/d; n = 23). Both groups participated in a 12-week, eucaloric, lifestyle modification intervention consisting of exercise training and nutritional counseling. The intervention increased the total Canadian Healthy Eating Index score (p < 0.001) with no differences between groups. The “other food” sub-score improved more in RDa than LDa (p = 0.02), and the “saturated fat” sub-score increased more in LDa than RDa (p = 0.02). The intervention significantly increased the consumption of dairy-related nutrients more in RDa than LDa (p < 0.05). The intervention also decreased snack size in both groups (p = 0.01) and improved percentage of healthy snack energy intake more in RDa than LDa (p = 0.04). More servings of dairy products were consumed as snacks than at breakfast, lunch, or dinner (p < 0.05). Thus, our study improved diet quality, and dairy product consumption improved intakes of key related nutrients and snack consumption in adolescents with OW/OB.

Prevalence of abdominal obesity and associated risk factors among women civil servants in Addis Ababa, Ethiopia, 2021: an institution-based study

Background

Abdominal obesity increases the risk of cardio-metabolic diseases, disability, and poor quality of life, as well as health-care costs. It is a component of the metabolic syndrome, along with hypertension, diabetes, and dyslipidemia. The goal of this study was to determine the prevalence of abdominal obesity and associated risk factors among female civil servants in Addis Ababa, Ethiopia in 2021.

Methods

An institution-based cross-sectional study was undertaken from March31^st to April 15^th, 2021.A multi-stage sampling technique was employed to select 478 study participants. Data was entered into EpiData version 3.1 and then exported to SPSS version 21 for analysis. A descriptive data analysis was used to present the distribution of study variables. Bivariable and multivariable analyses were used to assess the relationship between independent variables and abdominal obesity at 95% CI. The level of statistical significance was declared at a p-value less than 0.05.

Result

The prevalence of abdominal obesity defined by waist circumference was found to be29.5% (95% CI: 25.39-33.6%) and 32.8% (95% CI: 28.57%-37.03%) by waist hip ratio, respectively. Age group 29-37 years [AOR= 2.451, 95% CI: (1.199-5.013)], age group 38-46 years [AOR=3.807, 95% CI: (1.328-10.914)], age group 47-55 years [AOR=6.489, 95% CI: (1.367-30.805)], being married [AOR= 4.762, 95% CI: (2.321-9.721)],consumption of meat >=5 per week[ AOR= 4.764, 95% CI: (1.939-11.711)], having lunch daily[AOR= 0.388, 95% CI:(0.166-0.910)] and snack consumption [AOR=4.163, 95% CI:(1.503-11.534)] were significantly associated with abdominal obesity.

Conclusion

The prevalence of abdominal obesity as measured by waist circumference and waist hip ratio was found to be moderate and high, respectively. Age, being married, high consumption of meat, and having lunch daily were identified as associated with abdominal obesity. Healthy diet health education and nutrition intervention should be considered, with a focus on married, meat-consuming, and older age-group female civil servants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00613-9.

The association between later eating rhythm and adiposity in children and adolescents: a systematic review and meta-analysis

CONTEXT

Childhood adiposity, an important predictor of adult chronic disease, has been rising dramatically. Later eating rhythm, termed night eating, is increasing in adults but rarely studied in younger ages.

OBJECTIVE

The objective of this study was to review the association between later eating rhythm and adiposity in children and adolescents. The aspects of later eating being considered included: energy intake (for evening main meal, evening snack, whole evening period, and around bedtime); timing (any food eaten at later timing); and meal frequency in the evening/night (evening main meal skipping, evening snack consumption).

DATA SOURCES

Five databases (the Cochrane Library, CINAHL, Embase, MEDLINE (via OVID), and Web of Science) were searched for eligible articles published prior to and including August 2020.

DATA EXTRACTION

Data extraction and quality assessment were conducted by 2 reviewers independently.

DATA ANALYSIS

Forty-seven studies were included, all of which were observational. Meta-analysis showed positive associations between both higher energy intake around bedtime (odds ratio [OR] 1.19, 95% CI 1.06, 1.33) and evening main meal skipping (OR 1.30, 95% CI 1.14, 1.48), and adiposity. There was evidence to suggest that consuming evening snacks reduced adiposity, but it was very weak (OR 0.80, 95% CI 0.62, 1.05). No association was seen between eating later and adiposity (OR 1.04, 95% CI 0.68, 1.61). In the narrative analysis, approximately half of the studies suggested that there was no association between later eating rhythm and adiposity, either as a whole or within exposure subsets.

CONCLUSION

The magnitude of the relationship between later eating rhythm and adiposity is very small, and may vary depending on which aspects of later eating rhythm are under consideration; however, the evidence for this conclusion is of very low certainty . Further research with a more consistent definition of "later timing", and longitudinal studies in different populations, may lead to different conclusions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42019134187.

The association between meal regularity and weight loss among women in commercial weight loss programs

BACKGROUND/OBJECTIVES

While many obesity studies have pointed out the importance of meal regularity, few have conducted empirical analyses using data from food diaries. We examined the association between meal regularity (i.e., meal time regularity [MTR] and calorie intake regularity [CIR]) and weight loss.

SUBJECTS/METHODS

We collected food diary data from 637 women who had participated in commercial weight loss programs for 28–168 days (4–24 weeks). This study defined “meal regularity” in terms of two concepts: MTR and CIR. MTR refers to how regularly people eat their meals (i.e., at certain times each day), whereas CIR refers to how regularly people consume a certain amount of calories at each meal. We conducted multiple regression analyses.

RESULTS

MTR (model 1: β = −2,576.526, P < 0.001; model 2: β = −1511.447, P < 0.05; model 3: β = −1,721.428, P < 0.05) and CIR (model 1: β = −1,231.551, P < 0.01; model 2: β = −2,082.353, P < 0.001; model 3: β = −1,343.490, P < 0.01) turned out to be significant determinants of the amount of weight loss in breakfast, lunch, and dinner contexts. While meal regularity (i.e., MTR and CIR) was significantly associated with weight loss, daily calorie intake from meals was not significantly associated with the amount of weight loss (model 1: β = 0.13, P > 0.05; model 2: β = 0.11, P > 0.05; model 3: β = 0.14, P > 0.05). Subjects who consumed an equal amount of calories per meal throughout the day lost more weight than those who did not (model 4: β = −3,675.51, P < 0.001).

CONCLUSIONS

Eating each meal (i.e., breakfast, lunch, and dinner) at a certain time every day may increase weight loss success. Also, consuming the same amount of calories at each meal may help weight loss success.

Dietary Habits and Obesity among Adolescent School Children: A Case Control Study in an Urban Area of Kancheepuram District

BACKGROUND

Obesity is an important public health problem and is on the rise among adolescents in developed and developing nations. This case-control study was done to assess the dietary risk factors associated with obesity among school children of the adolescent age group.

MATERIALS AND METHODS

This study was done among age-matched 110 cases and 110 controls who were adolescent children between ages 10 and 17 years. Data were collected using a pretested, structured, interviewer-administered questionnaire and was analyzed using descriptive and analytical statistics.

RESULTS

About 52.7% of children belonged to the age group 13-15 years. Adequate fruits intake was reported by 42.7% of obese adolescents and 60% of nonobese adolescents. Adequate intake of vegetables was noted in 20.9% of cases and 24.5% of controls. The risk factors which were found to be statistically associated with adolescent obesity were increased fast food intake, sweets consumption, inadequate fruit intake, and the liberty given by the parents in purchasing snacks.

CONCLUSIONS

Since adolescent obesity is rising at an alarming rate, the dietary determinants of obesity need to be addressed at the level of schools, families, and community. School health services should include education on healthy food habits and regular monitoring of the health status of children. Parents need to be aware on the significance of balanced diet, avoidance of junk foods, and ensure adequate intake of fruits and vegetables for their children to prevent early onset of noncommunicable diseases.

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.

Obesity Prevalence and Determinants among Young Adults, with Special Focus on Normal-Weight Obesity; A Cross-Sectional Study in Mumbai

Background

India has >135 million obese individuals at present. Body mass index (BMI) has been used to assess obesity until recent times. Later, studies have shown that central body fat (BF) measurements as a reliable predictor of metabolic diseases. Hence, normal-weight obesity (NWO) is defined. Those with a normal range of BMI but increased fat percentage are found to be having metabolic syndromes at a very early life. The young adult group is specifically focused on the study with diet and physical activity as potential determinants; as an intervention at the right time can prevent the development of many noncommunicable diseases.

Objectives

The aim of this study is to estimate the prevalence of obesity and its determinants with special reference to NWO.

Materials and Methods

A cross-sectional study was conducted based on diet, physical activity, and other lifestyle factors on a sample of 269 young adults. Using Harpenden skinfold calipers, BF percentage was calculated based on Jackson and Pollock and Siri's equation. Binary logistic regression was also applied appropriately.

Results

The proportion of obesity was 42.01%, and that of NWO was 16.1%. Sex, high protein diet, number of restaurant visits, less homemade tiffin intake, heavy physical activity, alcohol intake were found to be significantly associated with obesity. Intake of fish, physical activity, protein diet, day-time sleep were found to be significantly associated with NWO.

Conclusion

The study emphasizes the need for including BF percentage in addition to BMI in regular clinical practice. It may help in preventive and promotive efforts.

Association of Video Game Use With Body Mass Index and Other Energy-Balance Behaviors in Children

Importance

Childhood obesity is one of the biggest public health threats facing the UK, and video game use is considered a risk behavior for obesity among children. However, few studies have explored the prospective association between video game use and body mass index (BMI) or the potential mediators of this association.

Objectives

To investigate whether a longer-term association exists between video game use at a young age and BMI SD score in later years, independent of television use, and to ascertain whether this association is mediated by other energy-balance behaviors.

Design, Setting, and Participants

This cohort study is a secondary analysis of data from the Millennium Cohort Study, a nationally representative sample of children who were born in the UK between September 1, 2000, and January 31, 2002, that focused on data collected when the children were aged 5, 7, 11, and 14 years. Data for all variables, except BMI, were provided by parental or caregiver reporting if the children were younger than 14 years of age. At age 14 years, the children self-reported their own behavior. Initial data analysis was conducted between September 18, 2018, and September 28, 2018, with supplementary analyses conducted from October 7, 2019, to November 22, 2019.

Main Outcomes and Measures

The main outcome variable was BMI SD scores, with video game use as the exposure variable of interest. Physical activity, bedtime regularity, sugar-sweetened beverage consumption, and high-calorie food consumption were included as potential mediating behaviors.

Results

The full sample comprised 16 376 children and had a nearly equal number of boys (8393 [51.3%]) and girls (7983 [48.7%]). Every 1 SD increase in the number of hours of video game use at age 5 years was associated with a β = 0.018 higher BMI SD score at age 14 years (95% CI, 0.004-0.032). A small partial mediation of this association was found (direct association: β = 0.017 [95% CI, 0.003-0.031]; indirect association: β = 0.0011 [95% CI, 0.0003-0.0019]), suggesting that irregular bedtimes and higher consumption of sugar-sweetened beverages were mediators. The mediation model accounted for 36.7% (95% CI, 35.5-37.8) of the variance of the BMI SD score at age 14 years.

Conclusions and Relevance

Results of this study suggest a small (and not clinically meaningful) association between video game use in early childhood and higher BMI in later years, which may be mediated by irregular bedtimes and higher consumption of sugar-sweetened beverages. Future interventions to prevent childhood obesity should incorporate health promotion in mainstream video games to target children most at risk because of their high level of video game use.

Energy-dense nutrient-poor snacks and risk of non-alcoholic fattyliver disease: a case-control study in Iran

OBJECTIVE

The purpose of the present study was to determine the association between energy-dense nutrient-poor snacks intake and the risk of non-alcoholic fatty liver disease (NAFLD) in Iranian adults. For this purpose, a total of 143 cases with a newly confirmed diagnosis of NAFLD and 471 controls free of the disease were studied. Dietary intake was assessed using a food frequency questionnaire.

RESULTS

The percentage of calories from total energy-dense nutrient-poor snacks was 6.08% and 5.04%, in patients and controls, respectively (P = 0.036). Compared with subjects in the lowest quartile of total energy-dense nutrient-poor snacks intake, the risk of NAFLD for those in the top quartile of consumption increased by about two times, in both crude (OR: 1.94; 95% CIs 1.16-3.26; P for trend = 0.015) and adjusted (OR: 2.27; 95%CIs 1.19-4.31; P for trend = 0.001) models. The relative odds of NAFLD increased significantly in the fourth quartile of dietary cake and biscuit (OR: 1.21, P for trend = 0.037) and soft drinks (OR: 1.64, P for trend = 0.005) intake compared with the lowest corresponding quartiles, after adjustment for age, sex, body mass index, physical activity, alcohol, energy intake. Our results indicate that there might be a moderate positive association between energy-dense nutrient-poor snacks intake and risk of NAFLD.

Sociocultural Influences on Dietary Practices and Physical Activity Behaviors of Rural Adolescents-A Qualitative Exploration

In the aftermath of nutrition transition and ever-increasing sedentarism, adolescents globally are exposed to negative health consequences. Diverse sociocultural influences play a critical role in their adoption of unhealthy dietary practices and suboptimal physical activity behaviors. Context-specific understandings of how these sociocultural influences shape adolescents’ dietary and physical activity patterns in a rural, resource-limited setting remained elusive. Aiming to address the gap, this qualitative study explored adolescents’ and mothers’ perception of broader sociocultural aspects that sculpt the food choices, eating habits and physical activity behaviors of adolescents in Matlab, Bangladesh. Six digitally-recorded focus group discussions were transcribed verbatim, translated into English and analyzed thematically. Marked taste-driven dietary preference of adolescents and its prioritization within family by the mothers, popularity of street foods, better understanding of the importance of food hygiene and safety contrasting with narrow perception of balance and diversity in diet, peer influence along with deficient school and community food environment, internalization and rigidity of gender norms were found to be exerting major influence. The findings highlighted key targets for community-based nutrition interventions and endorsed thorough consideration of socio-cultural factors in formulating strategies to promote healthful eating and physical activity behaviors among the adolescents.

In Vitro Gastrointestinal Digestion and Colonic Fermentation of High Dietary Fiber and Antioxidant-Rich Mango (Mangifera indica L.) "Ataulfo"-Based Fruit Bars

Mango (Mangifera indica L.) is a tropical fruit which is considered to be a source of dietary fiber (DF) and phenolic compounds (PCs). In this study, high DF mango-based fruit bars were developed from whole mango (peel and pulp). The bars were evaluated for their nutritional composition, the bioaccesibility of PCs during gastrointestinal digestion, and the PCs metabolites profile after in vitro colonic fermentation. The amount of DF in a 30 g portion of mango bars was 9.5 g, i.e., 35% of the recommended daily intake. Phenolic acids such as gallic acid; cinnamic acids, such as ferulic, coumaric, and caffeic acids; flavonoids such as quercertin; and xanthones such as mangiferin and mangiferin gallate, were identified as the main PCs in the bars. The antioxidant capacity associated with the PCs profile, together with the high DF content are indicative of the potential functional features of these natural fruit bars. The bioaccesibility of PCs in the mango bar was 53.78%. During fermentation, the PCs were bioconverted mainly to hydroxyphenolic acids and the main short-chain fatty acid produced was acetic acid. The xanthone norathyriol was identified after 12 h of fermentation. This study on the digestion and colonic fermentation of mango-based bars using in vitro models provides hints of the potential physiological behavior of PCs associated with DF, which constitutes relevant information for further development of natural and health-promoting fruit-based bars.

Snacking in nutrition and health

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

A Median Analysis of Factors Influencing Body Fatness in Urban School-Age Children in Cameroon

Background

Childhood overweight/obesity is a fast growing public health problem in developing countries. The adverse health consequences of obesity have been attributed to higher body fat levels and this has drawn overwhelming attention towards more accurate assessment of body fat. The goal of this study is to evaluate the relationships between selected behavioral factors and percentage body fat (%BF) estimated using bioelectrical impedance analysis in school-age children.

Methods

A cross-sectional analysis was carried out in randomly selected 6- to 11-year-old children (507 boys and 501 girls). Percentage body fat was assessed using bioelectrical impedance analysis. The behavioral factors were reported by parents using a structured questionnaire. Multiple quantile regression analysis was used to evaluate the relationship between the selected behavioral factors and %BF.

Results

With quantile regression, the daily consumption of fruits and vegetables, daily breakfast consumption, and high physical activity (>4–7 times/week) were significantly (p < 0.001) associated with a 4.95, 3.29, and 3.66 decrease in median %BF, respectively. Also, consumption of snacks (>3 times a day) (p < 0.001), high sedentary lifestyle (>3–6 hours/day) (p < 0.001), and motorization to school (p < 0.005) significantly increased the median %BF by 3.69, 3.01, and 1.39, respectively. The largest changes in median %BF were observed in girls.

Conclusions

Efforts are needed using longitudinal studies to clarify the effects of these behavioral factors on %BF in different regions and ethnic groups of Cameroon and also to assess whether any observed differences are of clinical relevance.

Potential circadian and circannual rhythm contributions to the obesity epidemic in elementary school age children

Children gain weight at an accelerated rate during summer, contributing to increases in the prevalence of overweight and obesity in elementary-school children (i.e., approximately 5 to 11 years old in the US). Int J Behav Nutr Phys Act 14:100, 2017 explained these changes with the "Structured Days Hypothesis" suggesting that environmental changes in structure between the school year and the summer months result in behavioral changes that ultimately lead to accelerated weight gain. The present article explores an alternative explanation, the circadian clock, including the effects of circannual changes and social demands (i.e., social timing resulting from societal demands such as school or work schedules), and implications for seasonal patterns of weight gain. We provide a model for understanding the role circadian and circannual rhythms may play in the development of child obesity, a framework for examining the intersection of behavioral and biological causes of obesity, and encouragement for future research into bio-behavioral causes of obesity in children.

Dietary Patterns and Association with Obesity of Children Aged 6⁻17 Years in Medium and Small Cities in China: Findings from the CNHS 2010⁻2012

Childhood obesity is associated with both near- and longer-term health implications. Few studies have been conducted to explore the associations between dietary patterns and obesity among Chinese children and adolescents. The present study was designed to identify dietary patterns and their relationships with childhood obesity in medium and small cities. This is a cross-sectional study of children participants aged 6⁻17 years old in the 2010⁻2012 China Nutrition and Health Survey (CNHS). Socio-demographics, life-style, physical activity, anthropometric variables, and hundred-item food frequency questionnaires (FFQs) were collected. Household income was classified as low, middle, and high. Traffic tools, from non-advanced to advanced, included walking, biking, bus, and car. Dietary patterns were identified using factor analysis of data from FFQs. Two dietary patterns were identified: a Westernized pattern (i.e., high cakes, snacks, sugary beverages, aquatic products, red meat, fruits, and nuts) and a Traditional Chinese pattern (i.e., high cereals, tubers, legumes, fried cereal food, and vegetables). The Westernized pattern was positively correlated with energy intake, household income, traffic tools, and negative correlated with age and housework time. The Traditional Chinese pattern was positively correlated with age, energy intake, and housework time, and negatively correlated with household income and traffic tools. After adjusting for confounding factors, the Westernized pattern was found to be associated with BMI increment, yielding β coefficients (95% confidence interval, 95% CI) of 0.57 (0.40, 0.85) for the fourth quartile. In addition, the Westernized pattern was also found to be significantly associated with an increased risk of obesity, yielding an odds ratio (OR, 95% CI) of 1.49 (1.21, 1.84) from fully-adjusted confounders. Promoting healthier eating patterns could help to prevent obesity in Chinese children. The findings of this study could be used to guide the development of evidence-based preventive nutrition interventions to curb childhood obesity epidemic in small⁻medium cities in China.

Location influences snacking behavior of US infants, toddlers and preschool children

Background

Compare at-home and away-from-home snacking patterns of US infants and young children.

Methods

A secondary analysis was conducted using nationwide, cross-sectional dietary survey data from the US Feeding Infants and Toddlers Study (FITS) 2008. The sample included infants (6–11.9 months, n = 505), toddlers (12–23.9 months, n = 925), preschool children (24–47.9 months, n = 1461). Weighted population descriptive statistics (means and standard errors) were calculated using SAS. Significance was determined at P ≤ 0.05. The main outcome measures of the analyses were the percent of children consuming snacks by location (at home, away from home) and snacking period (morning, afternoon and evening), energy and food groups consumed during snacks.

Results

Snacking at home was more prevalent than snacking away from home (toddlers, 73% vs 27%; preschoolers, 67% vs 33%). Away-from-home snacks provided about 50 additional calories per day for toddlers (346 vs 298 kcal/day, P ≤ 0.05) and preschoolers (371 vs 326 kcal/day, P ≤ 0.05) versus snacks consumed at home. Caregivers made similar snack choices for toddlers and preschoolers (milk/milk products, fruit/juice, grains and sweets) but differed in frequency of consumption by location. Among toddlers, milk/milk products were the most frequently consumed snacks at home (66%), while sweets were the top snacks consumed away from home (69%). Among preschoolers, sweets were the top snacks both at home (60%) and away (83%).

Conclusions

Location is an important factor influencing snacking patterns of young children and should be considered when developing feeding guidelines. This data may be of use in the upcoming development of dietary guidelines in the U.S. for the population aged 0–2 years.

Prevalence of obesity in Italian adolescents: does the use of different growth charts make the difference?

BACKGROUND

Since populations are becoming increasingly multi-ethnic, the use of local or international charts is a matter of debate. This study aimed to evaluate how the choice of cut-off thresholds affected prevalence of underweight (UW), overweight (OW), obesity (OB) in 1200 11-12-year Italian adolescents, and how their somatic growth depended on parental origin.

METHODS

The height, weight and body mass index were expressed as standard deviation score (SDS) using Italian (ISPED-2006) and UK (UK-1990) charts. The classification of UW/OW/OB was computed with the IOTF international cut-offs, and thresholds were identified as centiles corresponding to BMI values of 18.5/25.0/30.0 kg/m² at 18-year in ISPED-2006 or UK-1990 references.

RESULTS

About 30% participants had non-Italian parents, above all from North-Africa and Romania. Referring to the UK-1990 charts, all groups showed negative mean SDS for height, and positive SDS for weight and BMI. Referring to the ISPED-2006 charts, all mean SDS were negative. Percentage of UW individuals was higher in accordance with ISPED-2006 than with UK-1990 charts, whereas percentages of OW/OB were higher with UK-1990 than ISPED-2006 charts. The results obtained using IOFT cut-offs were similar to UK-1990 cut-offs. These results were due to the different shape of age-dependent cut-off centiles. Independently by the parental origin, the percentages of adolescents classified as OW/OB were closer to the expected values using the ISPED-2006 then the UK-1990 cut-offs. The results suggested the use of the Italian references for adolescents with immigrant parents.

CONCLUSION

The use of local charts seems more appropriate at least in Italian adolescents in the age range studied.

Lifestyle factors associated with underweight among Japanese adolescents: a cross-sectional study

Background

Because underweight in adolescents poses several health problems, it is important to prevent it in adolescence. For the prevention of underweight, it is necessary to investigate risk factors, especially lifestyles, because these can be modified. However, a limited number of studies exist regarding lifestyle factors associated with underweight among adolescents. The present study aimed to investigate the relationship between lifestyle factors and underweight among Japanese adolescents.

Methods

Study subjects comprised 2641 seventh-grade school children (age 12 or 13 years) from the town of Ina, Saitama Prefecture, Japan. Measurements of height and weight were made for each subject, while information regarding lifestyles of each subject was obtained using a self-administered questionnaire. Underweight was determined by the age- and sex-specific body mass index cut-off points. A logistic regression model was used to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for underweight.

Results

Adolescents who ate slowly were more likely to be underweight than those who did not eat slowly; the OR (95% CI) was 2.78 (1.77–4.39) in boys and 2.69 (1.81–3.98) in girls. Girls who did not exercise were more likely than those who exercised to be underweight (OR: 1.64, 95% CI: 1.07–2.51).

Conclusions

The present study showed that eating slowly and exercise were associated with underweight among Japanese adolescents. These results suggest that eating speed and exercise need to be considered in school health programs for healthy body weight.

Exercise and eating habits among urban adolescents: a cross-sectional study in Kolkata, India

BACKGROUND

Unhealthy eating and lack of exercise during adolescence culminated into earlier onset and increasing burden of atherosclerotic cardiovascular diseases (CVDs) worldwide. Among urban Indian adolescents, prevalence of these risk factors of CVD seemed to be high, but data regarding their pattern and predictors was limited. To address this dearth of information, a survey was conducted among urban adolescent school-students in Kolkata, a highly populated metro city in eastern India.

METHODS

During January-June, 2014, 1755 students of 9th-grade were recruited through cluster (schools) random sampling. Informed consents from parents and assents from adolescents were collected. Information on socio-demographics, CVD-related knowledge and perception along with eating and exercise patterns were collected with an internally validated structured questionnaire. Descriptive and regression analyses were performed in SAS-9.3.2.

RESULTS

Among 1652 participants (response rate = 94.1%), about 44% had poor overall knowledge about CVD, 24% perceived themselves as overweight and 60% considered their general health as good. Only 18% perceived their future CVD-risk and 29% were engaged in regular moderate-to-vigorous exercise. While 55% skipped meals regularly, 90% frequently consumed street-foods and 54% demonstrated overall poor eating habits. Males were more likely to engage in moderate-to-vigorous exercise [adjusted odds ratio (AOR) = 3.40(95% confidence interval = 2.55-4.54)] while students of higher SES were less likely [AOR = 0.59(0.37-0.94)]. Males and those having good CVD-related knowledge were more likely to exercise at least 1 h/day [AOR = 7.77(4.61-13.07) and 2.90(1.46-5.78) respectively]. Those who perceived their future CVD-risk, skipped meals more [2.04(1.28-3.25)] while Males skipped them less [AOR = 0.62(0.42-0.93)]. Subjects from middle class ate street-foods less frequently [AOR = 0.45(0.24-0.85)]. Relatively older students and those belonging to higher SES were less likely to demonstrate good eating habits [AOR = 0.70(0.56-0.89) and 0.23(0.11-0.47) respectively]. A large knowledge-practice gap was evident as students with good CVD-related knowledge were less likely to have good eating habits [AOR = 0.55(0.32-0.94)].

CONCLUSIONS

CVD-related knowledge as well as eating and exercise habits were quite poor among adolescent school-students of Kolkata. Additionally, there was a large knowledge-practice gap. Multi-component educational interventions targeting behavioral betterment seemed necessary for these adolescents to improve their CVD-related knowledge, along with appropriate translation of knowledge into exercise and eating practices to minimize future risk of CVDs.

Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age

BACKGROUND/OBJECTIVES

The World Health Organization recommends to limit intake of free sugars to 5% of total energy per day because of the great impact of high sugar intake on body fat deposition, adiposity and dental caries. However, little data exist about total intake and sources of sugar in European children. Therefore, this paper aims to describe sugar intake and dietary sugar sources and associated factors.

SUBJECTS/METHODS

Three-day weighed dietary records were obtained at eight time points from children 1 to 8 years of age (n=995) in five European countries. Food items were classified into subgroups according to food composition. Linear mixed models were used to examine associated factors.

RESULTS

Total sugar intake increased from 65 g/day (30.0% of energy intake (E%)) at 12 months of age to 83 g/day (20.9 E%) at 96 months of age. Around 80% of children's sugar intake was derived from the following sources: milk and dairy products, fruits and fruit products, confectionary and sugar sweetened beverages (SSB). Total sugar intake and dietary sugar sources varied significantly by country of residence. Boys had a significantly (P=0.003) higher total sugar consumption than girls.SSB consumption was significantly higher in children from young mothers while sugar intake from fruit products was lower in children from mothers with lower educational status and those with higher birth order.

CONCLUSIONS

Sugar intake in our population was lower than in other studies. Total sugar intake was associated with country of residence and gender, while dietary sugar sources varied by country of residence, maternal age, education and birth order.

Snacking Among US Children: Patterns Differ by Time of Day

OBJECTIVE

Evaluate foods and beverages consumed, and energy and nutrient densities that constitute morning, afternoon, and evening snacking periods among children in the US.

DESIGN

Evaluate snacking behavior using the National Health and Nutrition Examination Survey, 2009-2012.

PARTICIPANTS

Children aged 4-8 and 9-13 years (n = 3,647).

VARIABLES MEASURED

Self-reported foods and beverages reported as snacks were aggregated into morning (0:00-12:00 hours), afternoon (12:00-18:00 hours), and evening (18:00-24:00 hour) snacking periods.

ANALYSIS

Intakes and amounts consumed during different snacking periods were analyzed from per capita weighted averages using SAS 9.2 and SUDAAN software. Statistical differences were detected using Student t test for means and chi-square test for prevalence data.

RESULTS

Snacking contributed 25% of daily energy in both age groups, with the morning snacking period contributing the least energy. The most frequently consumed food groups across all snacking periods were water, snacks and sweets, nonalcoholic beverages, milk and dairy, and fruit. Nutrient densities varied among different snacking periods; the morning snack period for 4- to 8-year-olds was the most nutrient dense.

CONCLUSIONS AND IMPLICATIONS

Snacking is an important contributor to energy and nutrients in children's diets, but foods and beverages selected vary by time of day and age. Modifying snacking choices, especially in the afternoon, could improve the nutritional quality of children's diets.

Prediction of metabolic syndrome by a high intake of energy-dense nutrient-poor snacks in Iranian children and adolescents

BACKGROUND

Our aim was to investigate the relationship between metabolic syndrome (MetS) and energy-dense nutrient-poor solid snacks intakes during 3.6 y of follow-up among children and adolescents.

METHOD

This population-based longitudinal study was conducted within the framework of the Tehran Lipid and Glucose Study, on 424 MetS free subjects, aged 6-18 y. Data on consumption of energy-dense nutrient-poor solid snacks, sweet and salty snacks, were collected at baseline (2006-2008). Logistic regression, adjusted for age, sex, total energy intake, physical activity, dietary fiber, family history of diabetes, and body mass index, was used to assess the relationship between snacks and incident MetS.

RESULTS

After adjustment for confounders, compared with the lowest quartile of total energy-dense nutrient-poor solid snacks, odds ratio of incident MetS in the highest quartile was 3.04 (95% confidence interval (CI): 1.11-8.49); for sweet snacks this was 2.88 (95% CI: 1.00-8.32), and for salty ones it was 2.85 (95% CI: 1.09-7.43). The risk of incident hypertension in the highest, compared with the lowest quartile of total and salty snacks, was 2.99 (95% CI: 1.00-8.93) and 3.35 (95% CI: 1.10-10.17), respectively.

CONCLUSION

Energy-dense nutrient-poor solid snacks, both salty and sweet, may have undesirable effects on the incidence of MetS, with salty snacks having the potential to increase risk of incident hypertension in children and adolescents as well.

An afternoon snack of berries reduces subsequent energy intake compared to an isoenergetic confectionary snack

Observational studies suggest that increased fruit and vegetable consumption can contribute to weight maintenance and facilitate weight loss when substituted for other energy dense foods. Therefore, the purpose of the present study was to assess the effect of berries on acute appetite and energy intake. Twelve unrestrained pre-menopausal women (age 21 ± 2 y; BMI 26.6 ± 2.6 kg m(-2); body fat 23 ± 3%) completed a familiarisation trial and two randomised experimental trials. Subjects arrived in the evening (~5pm) and consumed an isoenergetic snack (65 kcal) of mixed berries (BERRY) or confectionary sweets (CONF). Sixty min later, subjects consumed a homogenous pasta test meal until voluntary satiation, and energy intake was quantified. Subjective appetite (hunger, fullness, desire to eat and prospective food consumption) was assessed throughout trials, and for 120 min after the test meal. Energy intake was less (P<0.001) after consumption of the BERRY snack (691 ± 146 kcal) than after the CONF snack (824 ± 172 kcal); whilst water consumption was similar (P=0.925). There were no trial (P>0.095) or interaction (P>0.351) effects for any subjective appetite ratings. Time taken to eat the BERRY snack (4.05 ± 1.12 min) was greater (P<0.001) than the CONF snack (0.93 ± 0.33 min). This study demonstrates that substituting an afternoon confectionary snack with mixed berries decreased subsequent energy intake at dinner, but did not affect subjective appetite. This dietary strategy could represent a simple method for reducing daily energy intake and aiding weight management.