Contribution of snacks to dietary intakes of young children in the United States

Identifying the Leading Sources of Saturated Fat and Added Sugar in U.S. Adults

The 2020-2025 Dietary Guidelines for Americans recommend limiting intakes of saturated fat and added sugars (SF/AS) to <10% total energy. Data-driven approaches to identify sources of SF/AS are needed to meet these goals. We propose using a population-based approach to identify the leading food and beverage sources of SF/AS consumed by US adults. Foods and beverages reported as consumed were assessed from two, 24 h dietary recalls (24HRDR) from 36,378 adults aged 19 years and older from the 2005-2018 National Health and Nutrition Examination Survey. Intakes of SF/AS were aggregated across both 24HRDR to identify What We Eat in America food categories accounting for ≥90% of SF/AS, respectively, by the total population and within population subgroups. Data were weighted to estimate a nationally representative sample. Ninety-five discrete food categories accounted for ≥90% of the total SF/AS intakes for >88% of the representative sample of U.S. adults. The top sources of SF were cheese, pizza, ice cream, and eggs. The leading sources of AS were soft drinks, tea, fruit drinks, and cakes and pies. This analysis reflects a parsimonious approach to reliably identify foods and beverages that contribute to SF/AS intakes in U.S. adults.

Relations between the levels of moderate to vigorous physical activity, BMI, dietary habits, cognitive functions and attention problems in 8 to 9 years old pupils: network analysis (PACH Study)

BACKGROUND

Physical activity (PA) and dietary habits (DH) play a crucial role on quality of life and health outcomes from various aspects.

METHODS

This study aims to investigate the relations between recommended daily levels of moderate to vigorous physical activity (MVPA) in 8 to 9 year old pupils, and their body mass index (BMI), DH, cognitive functions and attention problem scores by network analysis. Study participants were split into two groups based on their MVPA levels on weekdays.

RESULTS

Our findings suggest that children who reach recommended MVPA levels consume more vegetables and fruits, eat breakfast more frequently, have better motor speed and lower impulsivity score.

CONCLUSIONS

The number of interlinkages between various parameters in network structure for children who do not reach recommended MVPA levels is greater and more intense, highlighting the differences between the groups and suggesting that different interventions and approaches to improve/change lifestyle habits might be used.

Food sources of fiber and micronutrients of concern among infants and young children in Lebanon: a national cross-sectional study

BACKGROUND

Intakes of fiber, iron, zinc, calcium, vitamin D, vitamin A, and folate were shown to be low in a substantial proportion of infants and children in Lebanon. The study aims to identify the top food sources of fiber, iron, zinc, calcium, vitamin D, vitamin A, and folate amongst infants and young children in Lebanon and to evaluate the evolution of food sources of these nutrients from the beginning of the complementary feeding journey up until the age of 47.9 months.

METHODS

A national cross-sectional survey was conducted in 2012 as part of the "Early Life Nutrition and Health in Lebanon" project using stratified cluster sampling. Dietary intakes for infants and young children aged 6-47.9 months (n = 763) were assessed using 24- Hour Dietary Recall. Food items were categorized into food groups and the percent contribution of each food group to nutrient intakes was determined to identify the top food sources of fiber and selected micronutrients for three age groups: 6-11.9 m (infants), 12-23.9 m (toddlers), and 24-47.9 m (preschoolers).

RESULTS

The top food source of fiber was vegetables among children aged 6-47.9 months. Among infants and toddlers, infant/young child formula was the main contributor to iron, zinc, calcium, vitamin D, vitamin A, and folate intakes. Baby cereals also contributed to around 14% of iron intakes among infants. Among preschoolers, meat and fish contributed to 13% of iron intakes and 29% of zinc intakes, while cow's milk was the major contributor of calcium (41%), vitamin D (81%) and vitamin A (25%) intakes. Sweetened beverages and sweet bakery were also ranked among the major food sources contributing to substantial intakes of key nutrients, including fiber, iron, zinc, calcium, vitamin A, and folate among infants, toddlers, and preschoolers.

CONCLUSIONS

In addition to milk sources, vegetables, beans and legumes, breads, meats, and rice and pasta, sweet bakery and sweetened beverages have contributed to intakes of key nutrients from early ages. This calls for implementing initiatives and designing approaches to support nutrition education and improve nutrient intakes in infancy and early childhood.

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.

Snacks contribute considerably to total dietary intakes among adults stratified by glycemia in the United States

Little is known about the snacking patterns among adults with type 2 diabetes. The contribution of snacks to energy and nutrient intakes is important to further understand dietary patterns and glycemic control. The purpose of this study is to evaluate snack consumption among adults according to diabetes status in the United States. One NHANES 24-hour dietary recall for each participant collected between 2005-2016 was utilized for analysis (n = 23,708). Analysis of covariance was used to compare differences in nutrient and food groups intakes from snacks across levels of glycemic control, while controlling for age, race/ethnicity, income, marital status, and gender. Results of this analysis inform that adults with type 2 diabetes consume less energy, carbohydrates, and total sugars from snacks than adults without diabetes. Those with controlled type 2 diabetes consumed more vegetables and less fruit juice than other groups, yet adults with type 2 diabetes in general consumed more cured and luncheon meats than adults without diabetes or with prediabetes. Protein from all snacks for those without diabetes is higher than all other groups. This study elucidates common snacking patterns among US adults with diabetes and highlights the need for clinicians and policymakers to take snacking into consideration when evaluating and providing dietary recommendations.

Age-related differences in eating location, food source location, and timing of snack intake among U.S. children 1-19 years

BACKGROUND

Snacking is nearly universal and contributes significant energy to U.S. children's diets. Little is known, however, about where and when snacking intake occurs and if such patterns change with age. This research evaluated age-related differences in eating location, food source location, and timing of snacking among U.S. children aged 1-19 years (y).

METHODS

A cross-sectional analysis of snacking among 14,666 children in the 2007-2018 U.S. National Health and Nutrition Examination Survey was conducted using a single 24-hour dietary recall. Snacking was participant-defined and included all eating occasions outside of meals. Linear regression and analysis of covariance were used to examine the effects of age (toddler 1-2 y, preschooler 3-5 y, school-age 6-11 y, adolescent 12-19 y) on the percentage of daily snack energy consumed by eating location (at home vs. away from home), food source location (grocery store, convenience store, school/childcare, restaurant, from someone else (i.e. "socially"), and other), and time of day (morning, 6am-12pm; early afternoon, 12pm-3pm; late afternoon/afterschool 3pm-6pm; evening 6pm-9pm, late-night 9pm-12am, and overnight 12am-6am).

RESULTS

On average, U.S. children consumed most of their daily snacking energy at home (71%), from foods and beverages obtained from grocery stores (75%), and in the late afternoon/afterschool (31%). Toddlers and preschoolers consumed a greater percentage of their daily snack energy during the morning hours compared to school-age children and adolescents (both p < 0.001); school-age children consumed the most in the evening (27%, p < 0.001), and adolescents consumed the most in the late-night period (22%, p < 0.001). Age-related increases were seen in the percentage of daily snacking energy eaten outside the home (p < 0.001), and obtained socially (p < 0.001), from restaurants (p < 0.001), and convenience stores (p < 0.001).

CONCLUSION

Findings reveal age-related differences in eating location, food source location, and timing of snack intake among U.S. children aged 1-19 y. Younger children consume a greater percentage of snacking calories in the morning and at home relative to older children. School-age children and adolescents show greater snacking in the evening and at night and from foods obtained and eaten outside the home. Efforts to promote healthy snacking behaviors among children should consider developmental differences in snacking patterns.

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.

Caregiver perceptions of snacks for young children: A thematic synthesis of qualitative research

Snacks are inconsistently defined in nutrition research and dietary guidelines for young children, challenging efforts to improve diet quality. Although some guidelines suggest that snacks include at least two food groups and fit into an overall health promoting dietary pattern, snacks high in added sugars and sodium are highly marketed and frequently consumed. Understanding how caregivers perceive "snacks" for young children may aid in development of effective nutrition communications and behaviourally-informed dietary interventions for obesity prevention. We aimed to synthesize caregivers' perceptions of snacks for young children across qualitative studies. Four databases were searched for peer-reviewed qualitative articles including caregiver perceptions of "snacks" for children ≤5 years. We conducted thematic synthesis of study findings, concluding with the development of analytical themes. Data synthesis of fifteen articles from ten studies, conducted in the U.S., Europe, and Australia, revealed six analytical themes that captured food type, hedonic value, purpose, location, portion size, and time. Caregivers perceived snacks as both "healthy" and "unhealthy" foods. Less healthy snacks were described as highly liked foods, which required restriction and were consumed outside the home. Caregivers used snacks to manage behavior and curb hunger. Snack portions were described as "small", although caregivers reported various methods to estimate child portion size. Caregivers' perceptions of snacks revealed opportunities for targeted nutrition messaging, especially supporting responsive feeding and nutrient-dense food choices. In high-income countries, expert recommendations should consider caregivers' perceptions of snacks, more clearly defining nutrient-dense snacks that are enjoyable, achieve dietary requirements, reduce hunger, and promote healthy weight.

The effects of snack foods of different energy density on self-served portions and consumption in preschool children

It is recommended that preschoolers serve themselves their own food portions; however, it is unclear what factors influence the amount they select for consumption, and particularly how their selected portions are influenced by food properties such as energy density, volume, and weight. We offered preschool children snacks differing in energy density (ED) and investigated the effects on the amounts they served and then consumed. In a crossover design, 52 children aged 4-6 y (46% girls; 21% overweight) ate an afternoon snack on 2 days in their childcare classrooms. Before each snack time, children served the amount they would like to eat of 4 snacks presented in equal volumes but differing in ED (higher-ED: pretzels, cookies; lower-ED: strawberries, carrots). Across the 2 sessions, children were given their self-served amount of either pretzels (3.9 kcal/g) or strawberries (0.3 kcal/g) and intake was measured. Later, children tasted all 4 snacks and rated liking. Results showed that the portions children served themselves were influenced by their liking ratings (p = 0.0006), but after accounting for liking, the volumes they served were similar for all 4 foods (p = 0.27). At snack time, children ate a greater proportion of self-served strawberries (92 ± 4%) than pretzels (73 ± 4%; p = 0.0003), but because of the ED difference they consumed 55 ± 4 kcal more from pretzels than strawberries (p < 0.0001). The difference in snack intake by volume was not attributable to liking ratings (p = 0.87). That children served a consistent volume of similarly-liked snacks suggests that their portions were affected more by visual cues than by weight or energy content. Despite eating a greater volume of lower-ED strawberries, children consumed more energy from the higher-ED pretzels, highlighting the contribution of energy density to children's energy intake.

Free sugar intake from snacks and beverages in Canadian preschool- and toddler-aged children: a cross-sectional study

BACKGROUND

Excess consumption of free sugar (FS) increases the risk of dental caries and unhealthy weight gain. However, the contribution of snacks and beverages to young children's FS intake is not well understood. The purpose of this study was to determine FS intake from snacks and beverages among preschool-aged Canadian children.

METHODS

This cross-sectional study examined baseline data from 267 children 1.5 to 5 y enrolled in the Guelph Family Health Study. Dietary assessment was completed over a 24-h period using ASA24-Canada-2016 to, 1) estimate the proportion of children whose FS intake from snacks and beverages consumed exceeded 5% total energy intake (TE) and 10% TE, and 2) identify the top snack and beverage sources of FS.

RESULTS

FS contributed 10.6 ± 6.9% TE (mean ± SD). 30 and 8% of children consumed ≥ 5% TE and ≥ 10% TE from snack FS, respectively. Furthermore, 17 and 7% of children consumed ≥ 5% TE and ≥ 10% TE from beverages FS, respectively. Snacks and beverages accounted for 49 ± 30.9% of FS energy. Top snack sources of FS (% children, children's %TE from FS) were bakery products (55%, 2.4%), candy and sweet condiments (21%, 3.0%), and sugar-containing beverages (20%, 4.1%). Top sugar-containing beverage sources of FS (48%, 5.3%) were 100% fruit juice (22%, 4.6%) and flavored milk (11%, 3.1%).

CONCLUSIONS

Snacks and beverages contributed nearly half of FS intake among a sample of young children in Canada. Thus, long-term monitoring of snacking behavior and consumption of FS is warranted. These findings may help inform nutritional strategies and public policies to improve diet quality and FS intake in preschool-aged children.

TRIAL REGISTRATION

The Clinical Trial Registry number is NCT02939261 from clinicaltrials.gov. Date of Registration: October 20, 2016.

Healthy Snacks and Drinks for Toddlers: A Qualitative Study of Caregivers' Understanding of Expert Recommendations and Perceived Barriers to Adherence

BACKGROUND

Despite expert recommendations, most toddlers consume sugary drinks and more sweet and salty snack foods than fruits and vegetables as snacks. Studies have examined toddler caregivers' reasons for providing sugary drinks, but few have examined the reasons for providing nutritionally poor snack foods.

METHODS

Researchers conducted focus groups in one low-income community to assess caregivers' familiarity, understanding and attitudes regarding healthy drink and snack recommendations for toddlers. A convenience sample of 24 caregivers of toddlers (12-36 months) participated. Researchers conducted a descriptive analysis of the participants' familiarity with recommendations and a thematic analysis of the barriers to adherence.

RESULTS

Most participants were familiar with recommendations, but many were surprised that some drinks and snack foods are not recommended, and most believed recommendations were not realistic. Common barriers to adhering to recommendations included beliefs about their child's innate preferences, family modeling and others' provision of drinks and snacks in and outside the home. Practical barriers included the higher cost and inconvenience of serving fruits and vegetables on-the-go.

CONCLUSION

Similar barriers limited caregivers' adherence to expert recommendations about healthy snacks and drinks for toddlers. Nutrition education interventions should provide practical strategies for addressing these barriers and enlist childcare and health providers to reinforce recommendations.

Fruit and vegetable consumption as a preventative strategy for non-communicable diseases

A high intake of fruit and vegetables (FV) has consistently been associated with a reduced risk of a number of non-communicable diseases. This evidence base is largely from prospective cohort studies, with meta-analyses demonstrating an association between increased FV intake and reduced risk of both CHD and stroke, although the evidence is less certain for cancer and diabetes. Controlled intervention trials examining either clinical or intermediate risk factor endpoints are more scarce. Therefore, evidence that FV consumption reduces the risk of disease is so far largely confined to observational epidemiology, which is hampered by some methodological uncertainties. Although increased FV intake is promoted across all dietary guidelines, national surveys confirm that dietary intakes are suboptimal and are not increasing over time. A range of barriers to increasing FV intake exist, including economic, physical and behavioural barriers that must be considered when exploring potential opportunities to change this, considering the feasibility of different approaches to encourage increased FV consumption. Such interventions must include consideration of context, for example, challenges and uncertainties which exist with the whole food system.

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.

Contribution of Snacks to Dietary Intakes Stratified by Race/Ethnicity in the United States

BACKGROUND

Snacking recommendations do not exist, yet snacks contribute substantially to daily energy intakes. While dietary intakes of adults in the United States vary by race/ethnicity, little is known about their snacking patterns. The aim of this study was to assess the quality of snacks stratified by race/ethnicity in adults who participated in the 2011-2018 National Health and Nutrition Examination Survey (NHANES).

METHOD

Dietary data from 18,679 adults older than 19 years were assessed to examine differences in intakes from snacking occasions by self-identified race/ethnicity. Mean intakes were estimated for total snacking occasions, percentage of day, nutrient density per 100 kcals, and the average snack. Healthy Eating Index-2015 (HEI) scores were computed for intakes from total day, snack only, and meals only. Analysis of covariance assessed differences between racial/ethnic groups. US Department of Agriculture food categories determined sources of snack foods. Data were weighted to create a nationally representative sample.

RESULTS

Asians consumed the least amount of daily energy in the form of snacks, while Blacks and Whites consumed the most. Mean intakes of saturated fats and added sugars consumed during snacking occasions were significantly lowest in Asians, and highest in Blacks and Whites. While total and percentage of daily intakes of sodium were lowest in Asians during snacking occasions, they had significantly lowest meal-only HEI sodium subscore, indicating higher sodium consumption of sodium during mealtimes.

CONCLUSIONS

Diet quality of snacks varies significantly by race/ethnicity. These data support the need for development of snacking recommendations with culturally appropriate dietary interventions.

Growing Healthy Together: A Randomized Clinical Trial Using Parent Mentors for Early Childhood Obesity in Low-Income, Latino Families

Background: Parent mentors are a potential community-based mechanism for delivering behavioral interventions. For communities at a higher risk of obesity and challenges with access to care, such as migrant and seasonal farm workers, this may be an effective intervention for obesity. This study examined the effect of parent mentors on weight outcomes. Methods: This randomized clinical trial assigned parents of 2- to 5 year-old children enrolled in Head Start 1:1:1 to control, a parent mentor teaching We Can!, or a parent mentor teaching an intervention derived from positive deviance methods. The parent mentor arms were designed to have weekly interactions and monthly community meetings over 6 months. The primary outcome was change in adiposity, as measured by body mass indices. Results: We randomized 188 parents, and 155 completed the 6-month visit. Most parents, 107 (58%), had less than a high school education, and 170 (90%) reported Latino ethnicity. In the intention-to-treat analysis, no difference between the groups was observed for change in percent distance from the median or BMI z-score. The median number of interactions was 14 (IQR 10-20) over 6 months for those who did engage, though 24 of 118 (20%) had no interaction. Those with no interactions in We Can! had a mean increase in change from median of 6.7 [standard deviation (SD) = 8.2]; those with higher participation experienced a 0.4 (SD = 9.2) change, p = 0.04. Conclusions: Parent mentors were not effective in changing the adiposity indices in this study overall, with some evidence of efficacy after accounting for participation. Clinicaltrials.gov registration number: NCT03330743.

Food and beverage offerings by parents of preschoolers: A daily survey study of dinner offerings during COVID-19

The COVID-19 pandemic is likely to have altered parents' daily feeding practices, including what and how much they feed their children, which may have negative implications for children's weight. The primary aim of this study was to examine patterns of and variation in parents' daily food and beverage offerings at dinner across 10 days during the COVID-19 pandemic using descriptive analysis and non-parametric tests. Ninety-nine parents (M_age = 32.90, SD_age = 5.60) of children ages 2–4 years (M = 2.82, SD = 0.78) completed an online baseline survey and 10 daily surveys (929 completed surveys) assessing their daily food and beverage offerings at dinner. On average, parents did not offer recommended foods and beverages on a daily basis; parents offered vegetables and protein most often across the 10 days, however, less than 50% of parents offered the recommended serving size for each group. The intraclass correlations and random sampling plots revealed considerable within-parent variation in food and beverage offerings. Eating dinner as a family, planning dinner in advance, and preparing a homemade dinner were associated with more vegetable and protein offerings, while processed, fast, or fried foods were offered less often when dinner was planned or homemade. Dairy, water, and refined grains were offered more often when dinner was homemade, while whole grains, processed, fast, or fried foods, and sugar-sweetened beverages were offered less often when dinner was homemade. The results provide documentation of parents' daily food and beverage offerings at dinner within the context of COVID-19 and point towards the importance of examining predictors and consequences of parents' daily feeding practices.

The Impact of Household Chaos and Dietary Intake on Executive Function in Young Children

Children's executive functions (EFs) emerge over time and can be shaped by household environments and dietary intake. However, there is a lack of knowledge about how these factors influence EFs in children aged 18-24 months. This study tested a model exploring the relations between parent-reported dietary intake, household chaos, and child EF. The sample consisted of 294 families participating in the STRONG Kids2 birth cohort study of nutrition and child health. Caregivers completed the Food Frequency Questionnaire (FFQ), the Confusion, Hubbub, and Order Scale (CHAOS), and the Behavior Rating Inventory of Executive Function^®-Preschool Version (BRIEF-P) to assess model variables. Regression analyses revealed a significant and independent association between assorted snacks and processed foods and two EF subscales. There were also significant associations between household chaos and each EF subscale. There was no significant moderation effect. These findings suggest that family households characterized by dysregulation are associated with children's EF difficulties during early childhood and that the role of unhealthy dietary intake in child EF should be explored further. Future longitudinal studies that include multi-method approaches are needed to document the mechanisms through which household chaos impacts child EF over time.

The consumption of energy dense snacks and some contextual factors of snacking may contribute to higher energy intake and body weight in adults

Preventing obesity (OB) among adults is a public health priority. One factor that seems to contribute to OB, due to the extra energy intake it involves, is the greater consumption of snacks. Whether snacking promotes OB in adults is however a source of controversy in the literature at present. The aim of this paper was to evaluate the effects of snacking on body weight status, along with contextual factors such as snacking location, food source, timing, and social context of snacking. To better understand the nature of snacking behavior, seven currently used definitions of snacking were described. Studies published prior to November 2020 were identified by searching the PubMed and Scopus databases, with thirty-three observational studies being identified and included. The consumption of energy-dense snacks may contribute to higher energy intake and weight in adult populations. The context in which adults snacks-such as eating alone, outside home or work, late in the day, in front of a TV or computer-is also important for this behavior. However, the lack of consensus on the definition of snacks in the literature makes these considerations suggestive rather than objective. Better-designed research is needed to determine the prospective association between snacking behavior and weight status in adults. Snacking may be an important behavior that can be modified to prevent obesity on the population level. Social education focused on promoting morning snacks and replacing energy-dense snacks by more nutritious ones, e.g. fruit and vegetables, may thus be beneficial.

Occasions, purposes, and contexts for offering snacks to preschool-aged children: Schemas of caregivers with low-income backgrounds

OBJECTIVE

Snacking among preschool aged children is nearly universal and has been associated with overconsumed nutrients, particularly solid fats and added sugars (SoFAS). This research examined caregivers' schemas, or cognitive frameworks, for offering snacks to preschool-aged children.

METHODS

A qualitative design utilizing card sort methods was employed. Participants were 59 Black, Hispanic, and White caregivers of children aged 3-5 years with low-income backgrounds. Caregivers sorted 63 cards with images of commonly consumed foods/beverages by preschool-aged children in three separate card sorts to characterize snacking occasions, purposes, and contexts. The mean SoFAS content (kcal/100 g) of foods/beverages was evaluated by occasions (snacks vs. not-snacks), purposes, and contexts.

RESULTS

Just under two-thirds (38/63 food cards) of foods/beverages were classified as snacks with moderate to high agreement. Snacks were offered for non-nutritive (e.g., requests, rewards) and nutritive (e.g., hunger/thirst) purposes in routine (e.g., home, school) and social contexts (e.g., with grandparents). Snacks offered for non-nutritive purposes and in social contexts were higher in SoFAS than those offered for nutritive reasons and in routine contexts.

CONCLUSIONS

Caregivers of young children offered various types of foods/beverages as snacks, with higher SoFAS snacks given for non-nutritive purposes and in social contexts. Understanding of caregivers' schemas for offering snacks to young children may inform targets for obesity prevention and anticipatory guidance to promote the development of healthful eating behaviors.

Dietary and Health Correlates of Sweetened Beverage Intake: Sources of Variability in the National Health and Nutrition Examination Survey (NHANES)

Recent studies using data from the National Health and Nutrition Examination Survey (NHANES) have used inconsistent approaches to identify and categorize beverages, especially those containing low-calorie sweeteners (LCS), also referred to as low-calorie sweetened beverages (LCSBs). Herein, we investigate the approaches used to identify and categorize LCSBs in recent analyses of NHANES data. We reviewed published studies examining LCS consumption in relation to dietary and health outcomes and extracted the methods used to categorize LCS as reported by the authors of each study. We then examined the extent to which these approaches reliably identified LCSBs using the Internet Archive Wayback Machine to examine beverage ingredients lists across three NHANES cycles (2011–2016). None of the four general strategies used appeared to include all LCSBs while also excluding all beverages that did not contain LCS. In some cases, the type of sweetener in the beverage consumed could not be clearly determined; we found 9, 16, and 18 of such “mixed” beverage identifiers in the periods 2011–2012, 2013–2014, and 2015–2016, respectively. Then, to illustrate how heterogeneity in beverage categorization may impact the outcomes of published analyses, we compared results of a previously published analysis with outcomes when “mixed” beverages were grouped either all as LCSBs or all as sugary beverages. Our results suggest that caution is warranted in design and interpretation of studies using NHANES data to examine dietary and health correlates of sweetened beverage intake.

Picture Perfect: How Attaining the Ideal Meal is Not So Easy for Parents of Young Children

OBJECTIVE

To explore parental perspectives on the ideals and realities of family mealtimes.

DESIGN

Mini-focus groups (n = 7).

SETTING

Rural Colorado, US.

PARTICIPANTS

Parents (n = 30) were recruited at Head Start/preschool centers.

PHENOMENON OF INTEREST

Parent perspectives on mealtimes with preschool-aged children.

ANALYSIS

Transcripts were analyzed using thematic analysis.

RESULTS

Three categories of themes emerged: participant conceptions of ideal family meals, challenges to achieving their ideal family meal, and parental solutions. The theme of participant conceptions of ideal family meals composed family togetherness, children liking and eating the prepared food, healthfulness of food, and a nonchaotic mealtime. Challenges to achieving their ideal family meal included work schedules, disruptive child behaviors, child pickiness, snacking, and negative role-modeling. Finally, parental solutions to challenges incorporated having flexible meal timings, considering child preferences in premeal preparations, role-modeling, and numerous other parenting strategies.

CONCLUSIONS AND IMPLICATIONS

While parents valued many aspects of a version of the ideal meal rooted in historical standards, families faced many challenges in trying to attain that ideal. Although parents employed various strategies to combat mealtime challenges, parental expectations for preschool-aged children's mealtime behaviors may be unrealistic for the developmental stage of early childhood. Future interventions could help parents develop age-appropriate mealtime expectations.

Comparative Analysis of the Effects of Daily Eating Habits and Physical Activity on Anthropometric Parameters in Elementary School Children in Latvia: Pach Study

Growing incidence of obesity and related diseases in children poses new challenges and calls for a review of lifestyle habits. This study aimed to assess daily eating habits (EH) and physical activity (PA) levels and identify their association with obesity in 8-10-year-old children. Children's EH and time spent in moderate-to-vigorous physical intensity (MVPA) was estimated from questionnaires (N = 1788). Weight, height, and waist circumference (WC) were collected, and body mass index (BMI) calculated. Girls consumed more fruits and vegetables, drank more water, and ate smaller portions of carbohydrate and protein rich foods but spent less time in MVPA compared to boys (p < 0.05). Obese children skipped breakfast more often and consumed less fruits and vegetables. Children who chose to eat in front of the screen had higher WC (62.88 ± 8.70 vs 60.59 ± 7.40 cm, p < 0.001) and higher BMI, and chose smaller vegetable portions and more calorie dense snacks (p < 0.001). 15.4% of pupils covered weekly MVPA recommendations with structured PA on weekdays. Increasing MVPA was related to a smaller number of unhealthy EH (p < 0.001). In conclusion, EH and PA levels differ between sexes and obese children have unhealthier EH. Higher levels of MVPA are related to healthier food choices, while pupils having meals in front of the screen have unhealthier EH and anthropometric measures. The majority of pupils did not reach the WHO recommendations of MVPA through structured PA on weekdays. Association between factors (EH and time spent in PA) and BMI was not found in this study.

Snack foods and lead ingestion risks for school aged children: A comparative evaluation of potentially toxic metals and children's exposure response of blood lead, copper and zinc levels

Snack foods are common and highly advertised to children and serve their natural predispositions for sweet and salty tastes. However, the risk issues of low-cost snacks eaten by 0-6 aged children are lack of more concern. To better understand the issue of low-cost snacks this study considered potentially toxic metals (PTMs) impact on children's health risk, measured PTMs in a collection of 570 collected low-cost snacks contributed by 1342 voluntary participants children aged 0-6 years involved in Xi'an city are conducted. Nine priority PTMs and amounts ranked as Mn > Zn > Cu > Cr > Sb > Pb > Ni > Cd > Co. The Estimated Weekly Intake of PTMs in snacks for children accounted for a proportion of the Provisional Tolerance Weekly Intake. Children's daily snack ingestion of Cr, Cd and Pb were especially concerning. It was noted that all PTMs in flour products contribute to the total Target Hazard Quotient (THQ>1) were observed having a non-carcinogenic risk compared to the single metals Cr, Co and Cd with carcinogenic risk. The correlations between Cu, Pb, Zn in low-cost snacks and children's bloods reflected PTMs especially for Pb that transfers into children's bodies mostly through low-cost foodstuffs ingestion. Also, the elevated blood lead levels (BLLs) depended on readily available, low-quality snacks accessible for children. Therefore, multi-initiatives aimed at improving the quality, increasing awareness, and a PTM monitoring program for low-cost snack food market to young children should be undertaken.

Bean-based nutrient-enriched puffed snacks: Formulation design, functional evaluation, and optimization

School-age children frequently consume snacks. However, most of the snacks they consume are of low nutritional quality. The objective of this study was to develop a nutrient-rich and acceptable extruded bean-based snack, which could contribute to improved nutrient intake, especially for school-age children. Snack formulations developed from Roba1 beans, maize, orange-fleshed sweet potato, and amaranth mixtures, and processed in a twin-screw extruder, were evaluated and optimized for nutritional, textural and sensory properties. High proportion of beans in the formulation was associated with high protein, iron, zinc, and dietary fiber content. An optimal formulation (82.03:10: 5:2.97; beans, maize, OFSP, amaranth), containing 20.38 g, 4.12 g, 4.83 mg, and 1.51 mg per 100 g, of protein, dietary fiber, iron, and zinc, respectively, was obtained. The snacks were crunchy and moderately acceptable with average sensory scores of 6 on a 9-point hedonic scale, and hardness 26.6 N. Nutrient contribution 43, 19, and 12% for protein, iron, and zinc, respectively, to children aged 6 to 8 years; and 24, 19, and 7.6%, respectively, to children aged 9 to 12 years from a 40 g serving was estimated from the snack. The results demonstrate the potential of using extrusion to produce nutrient enriched value-added food products from blends of iron-rich beans and common staples.

Snack Development for School Feeding Programs in Africa: A Scoping Review

The benefits of school feeding have been well documented. As such, school feeding programs have continuously gained popularity in developing countries. However, challenges and potential opportunities persist, calling for a review of school feeding for long-term sustainability. South Africa has an opportunity to improve their National School Nutrition Program (NSNP) by including an energy-dense snack that would increase the recommended dietary allowance (RDA) of school children to meet at least 25% of their energy requirements. The objective of this scoping review was to conduct a review and an appraisal of studies on snack food development for school feeding programs in Africa. Eligible studies had to report snack development for school feeding programs in Africa. We conducted an electronic search in National Research Foundation (NRF) NEXUS, Elton B. Stephens Company (EBSCO), International Food Information Service (IFIS), Nutrition and Food Sciences Center for Agriculture and Bioscience International (CABI.ORG), and Google Scholar. Of the 429 articles identified, nine studies were included in the final review-five from within South Africa and four from elsewhere in Africa. Data extracted included the study design, intervention, outcomes, relevant findings, and limitations. Results were presented in a narrative summary. The review findings showed that energy-rich staple foods and food fortification were commonly used in snack development. The popular snack products developed included porridges and biscuits. While most studies reported nutritional outcomes, few studies reported on sensory acceptability tests and only two studies conducted a cost analysis. This review of previous snack development initiatives for school feeding programs in Africa underscores the importance of establishing the sustainability of any food product developed. The findings of this review have the potential to inform future snack product development for school feeding programs.

A laboratory-based assessment of mother-child snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices

This study explored how mothers' observed and self-reported child feeding practices (child control over food choices, encouragement of balance and variety, and teaching about nutrition) were associated with mother-child snack food selections and child snack food consumption in a laboratory setting. Mothers (N = 107) and their 4.5-year-old children (52% female) selected up to 5 snack foods (out of 9 snack foods: 6 higher-energy-density [ED] and 3 lower-ED) for optional child consumption throughout a one-hour laboratory visit. Mothers' in-the-moment child feeding practices during the snack food selection task were coded using observational coding schemes, and mothers' global child feeding practices (i.e., across meals and snacking occasions) were self-reported using the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub, 2007). Results of multiple linear regression analyses with covariates showed that higher-ED snack food selections were positively associated with observed child control over food choices (B = 0.35, SE = 0.12, p = .006) and self-reported teaching about nutrition (B = 0.49, SE = 0.19, p = .010), and negatively associated with self-reported encouragement of balance and variety (B = -0.66, SE = 0.24, p = .007). Lower-ED snack food selections were positively associated with self-reported encouragement of balance and variety (B = 0.53, SE = 0.20, p = .008). Child consumption of higher-ED or lower-ED snack foods were not significantly associated with mothers' child feeding practices (observed or self-reported). We discuss the implications of these findings for future research on children's snack food selection and consumption.

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.

Differences in Diet Quality and Snack Intakes Among Non-Hispanic White and Mexican American Adolescents from Different Acculturation Groups

Mexican American adolescents have an increased risk for obesity compared to non-Hispanic whites (NHWs), especially as their degree of acculturation increases. Snack intakes can impact diet quality and may affect obesity risk, yet little is known about differences in snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study compared diet quality and snack intakes among NHW and Mexican American adolescents from different acculturation groups. This study used cross-sectional data from 3636 Mexican American and NHW adolescents in the 2005-2014 National Health and Nutrition Examination Survey. Acculturation was defined based on generational status and language use. Outcomes were Healthy Eating Index-2015 (HEI-2015) score, daily energy intake from snacks, snack frequency, energy value of snacks, and percent contribution of snacks to total daily energy. Analysis of covariance was used to compare outcomes across groups, after adjustment for sex and income. In the full sample, mean HEI-2015 score was 45 ± 0.4. Non-Hispanic white adolescents had modestly poorer diet quality compared to US-born adolescents with a foreign-born parent and Mexican-born adolescents (P < 0.001). Mean daily snack intake was 583 ± 16 kcal. Items in the Snacks and Sweets and Beverages categories contributed more than half of the energy provided by snacks. Non-Hispanic white adolescents had a greater total snack intake compared to all language use at home groups, except equal Spanish and English use. Improving the types of foods consumed as snacks has the potential to partially mitigate differences in snack intakes and diet quality among non-Hispanic white and Mexican American adolescents.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS/SETTING

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

MAIN OUTCOME MEASURES

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

STATISTICAL ANALYSES PERFORMED

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

RESULTS

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

CONCLUSIONS

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

Associations of Less Healthy Snack Food Consumption with Infant Weight-for-Length Z-Score Trajectories: Findings from the Nurture Cohort Study

Little is known about the impact of less healthy snack foods on weight trajectories during infancy. This secondary analysis of data from the Nurture cohort explored prospective associations of less healthy snack foods with infant weight trajectories. Pregnant women were recruited and, upon delivery of a single live infant, 666 mothers agreed to participate. Mothers completed sociodemographic and infant feeding questionnaires, and infant anthropometrics were collected during home visits at 3, 6, 9, and 12 months. Less healthy snack food consumption was assessed by asking how frequently baby snacks and sweets were consumed each day during the previous three months. Multilevel growth curve models explored associations of baby snacks and sweets with infant weight-for-length (WFL) z-scores. On average, mothers were 27 years old, 71.5% were non-Hispanic Black, and 55.4% had household incomes of ≤$20,000/year. Consumption of less healthy snack foods increased during infancy with a median intake of 3.0 baby snacks/day and 0.7 sweets/day between 10 and 12 months. Growth curve models showed that infants who consumed sweets >2 times/day had significantly higher WFL z-scores during the second half of infancy compared to infants who never consumed sweets. Less healthy snacks may contribute to the risk of obesity during infancy and promoting healthy snack food choices during this critical time is important.

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.

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.

Title: efficacy of a food parenting intervention for mothers with low income to reduce preschooler's solid fat and added sugar intakes: a randomized controlled trial

Background

Few interventions have shown efficacy to influence key energy balance behaviors during the preschool years.

Objective

A randomized controlled trial (RCT) was used to evaluate the efficacy of Food, Fun, and Families (FFF), a 12 week authoritative food parenting intervention for mothers with low-income levels, to reduce preschool-aged children’s intake of calories from solid fat and added sugar (SoFAS).

Methods

Mothers were randomly assigned to receive FFF (n = 59) or to a delayed treatment control (n = 60). The primary outcome was children’s daily energy intake from SoFAS at the end of the 12 week intervention, controlling for baseline levels, assessed by 24-h dietary recalls. Secondary outcomes included children’s daily energy intake, children’s BMI z-scores, and meal observations of maternal food parenting practices targeted in FFF (e.g. providing guided choices).

Results

Participating mothers were predominantly African American (91%), with 39% educated beyond high school and 66% unemployed. Baseline demographics and child SoFAS intakes did not differ by group. Lost to follow-up was 13% and did not differ between groups. At post-intervention, FFF children consumed ~ 94 kcal or 23% less daily energy from SoFAS than children in the control group, adjusting for baseline levels (307.8 (95%CI = 274.1, 341.5) kcal vs. 401.9 (95%CI = 369.8, 433.9) kcal, FFF vs. control; p < 0.001). FFF mothers also displayed a greater number of authoritative parenting practices when observed post-intervention with their child at a buffet-style meal (Wilcoxon z = − 2.54, p = 0.012). Neither child total daily energy intake nor BMI z-scores differed between groups post-intervention.

Conclusions

Findings demonstrate the initial efficacy of an authoritative food parenting intervention for families with low-income to reduce SoFAS intake in early childhood. Additional research is needed to evaluate longer-term effects on diet and growth.

Trial registration

Retrospectively registered at ClinicalTrials.gov: #NCT03646201.

Daily Snacking Occasions and Weight Status Among US Children Aged 1 to 5 Years

OBJECTIVE

To characterize associations of snacking frequency with weight status among US children aged 1 to 5 years.

METHODS

Participants were children (n = 4,669) aged 1 to 5 years in the 2005 to 2014 National Health and Nutrition Examination Survey (NHANES). Snacking was assessed by two 24-hour dietary recalls using definitions that considered "snack" occasions as well as other foods/beverages consumed between meals. Overweight/obesity (OW/OB) was defined using percentile cutoffs: ≥ 97.7th weight-for-length (< 2 years) cutoff and the ≥ 85th BMI-for-age (≥ 2 years) cutoff. Linear/logistic regressions evaluated snacking based on daily occasions and relative to current recommendations (two to three snacks per day).

RESULTS

During 2005 to 2014, US children aged 1 to 5 years consumed, on average, two to three snacks daily. Children with normal weight in both age groups tended to snack less frequently than children with OW/OB when considering all foods/beverages eaten between meals (P < 0.01-0.12). Across most snacking definitions, children < 2 years who snacked more frequently than recommended had greater odds of having OW/OB (P < 0.01-0.12) and consumed greater daily snack energy than those who snacked within recommendations (all P < 0.01). Recommendations did not clearly delineate weight status among children aged 2 to 5 years.

CONCLUSIONS

Snacking frequency and weight are positively associated among US children 1 to 5 years old, with most consistent associations seen among children < 2 years old and when considering all foods/beverages consumed between meals.

Contribution of snacks to dietary intakes of young children in the United States

Nutritional quality of children's diets is a public health priority in the fight against childhood obesity and chronic diseases. The main purpose of this study was to determine contribution of snacks to energy and nutrient intakes and to identify leading snack food sources of energy, total fat, and added sugars amongst young children in the United States. Using the 2005-2012 NHANES data, dietary intakes of 2- to 5-year-old children were analysed from a parent-reported 24-hour dietary recall (n = 3,429). Snacking occasions were aggregated to determine the proportion of total food/beverage intake obtained from snacks, estimate energy, and nutrient intakes, and identify the leading snack food sources of energy, added sugars, and total fat. Nearly all children consumed a snack on the reported day (62% morning, 84% afternoon, and 72% evening). Snacks accounted for 28% of total energy intake, 32% of carbohydrates, 39% of added sugars, and 26% of total fat and dietary fiber intakes for the day. Snacking occasions accounted for 46.6% of all beverages consumed on the reported day. Snacks and sweets food category (i.e., cookies and pastries) were the leading sources of energy (44%), total fat (52%), and added sugars (53%) consumed during snacking occasions. Sweetened beverages (e.g., fruit and sport drinks) contributed 1-quarter of all added sugars obtained from snacks. Snacks contribute considerable amount of energy and nutrients to young children's diets, with a heavy reliance on energy-dense foods and beverages. Targeted interventions are needed to improve the nutritional quality of snacks consumed by young children.