Less frequent eating predicts greater BMI and waist circumference in female adolescents

Meal Frequency Does Not Affect Weight Loss in Overweight/Obese Women but Affects the Body Composition: A Randomized Controlled Trial

OBJECTIVES

Studies showing the relationship between meal frequency, weight loss and anthropometric measurements are contradictory. This study aims to determine the effect of meal frequency on weight loss, anthropometric measurements, and body composition.

METHODS

This is a parallel designed randomized control trial that was conducted with 40 female volunteers between the ages of 19-64 years, with a Body Mass Index (BMI) ≥27 who applied to a private clinic. Participants were randomized in two treatment arms (3 meals + 3 snacks/day (n = 20) vs 3 meals/day (n = 20)) and same dietary energy restriction (-500kcal) was applied for 3 months. Food consumption was questioned with 3 day food records, and anthropometric measurements and body composition were measured before the study and repeated each week till the end of the study by the researcher.

RESULTS

All of the participants completed the study period. Body weight (kg), BMI (kg/m2), total body fat (kg), body fat percentage (%), fat free mass (kg) and waist circumference (cm) decreased, while fat free mass percentage (%) increased significantly in both of the groups at the end of the study (p < 0.05). The rate of difference for body weight, BMI (kg/m2) and waist circumference (cm) were similar among the groups. When difference in body composition analyses was examined, the rate of reduction in total body fat (-18.82 ± 4.97% vs -14.87 ± 7.44%) and body fat percentage (%)(-10.79 ± 4.63% vs -7.68 ± 7.04%) and the rate of increase in fat free mass percentage (%)(7.65 ± 3.16% vs 5.04 ± 3.44%) were significantly higher in 3 meals + 3 snacks group (p < 0.05).

CONCLUSION

When energy restricted and balanced weight loss programs are applied, alteration in body weight, BMI and waist circumference is not affected from meal frequency, but body composition does.

CLINICAL TRIAL NUMBER

NCT05581862 (Date of Trial Registration: 13/10/2022).

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

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.

Body Composition, Eating Habits, and Disordered Eating Behaviors among Adolescent Classical Ballet Dancers and Controls

Adolescent classical ballet dancers are nutritionally vulnerable, as they try to retain a lean body shape during a life period of high nutritional requirements due to rapid growth. Studies conducted on adult dancers have indicated a high risk for the development of disordered eating behaviors (DEBs), but research on adolescent dancers remains scarce. The aim of the present case-control study was to compare the body composition, dietary habits, and DEBs of female adolescent classical ballet dancers and their non-dancer same-sex peers. Self-reported questionnaires, namely the Eating Attitudes Test-26 (EAT-26) and a 19-item Food Frequency Questionnaire (FFQ), were used for the assessment of habitual diet and DEBs. The assessment of body composition included the measurements of body weight, height, body circumference, and skinfolds and bioelectrical impedance analysis (BIA). The results indicate that the dancers were leaner than the controls, with lower weight, BMIs, and hip and arm circumferences, leaner skinfolds, and less fat mass. No differences were observed between the two groups regarding eating habits and the EAT-26 scores, but almost 1 out of 4 (23.3%) participants scored ≥ 20, indicative of DEBs. Participants with an EAT-26 score ≥ 20 had significantly higher body weight, BMIs, body circumferences, fat mass, and fat-free mass than those with a score < 20. Adolescents must be educated on nutrition and healthy methods to control body weight through evidence-based information and programs, and whenever appropriate, also through individual counseling by the appropriate health professionals.

Association between Meal Frequency and Weight Status in Spanish Children: A Prospective Cohort Study

Childhood obesity is a major international problem, and unhealthy eating habits remain widespread. Increasing the frequency of meals of nutritious food can help children to regulate their appetite and maintain a healthy weight. However, there is scarce prospective evidence on the relationship between the meal frequency and weight outcomes. Therefore, the objective of the present study was to determine the prospective association between the meal frequency, body mass index, and waist circumference in Spanish children. Additionally, we analyzed the impact of the meal frequency on the incidence of excessive weight and abdominal obesity. The study included 1400 children with a mean (SD) age of 10.1 (0.6) and an average follow-up of 15 months. Anthropometric measurements, including the body weight, height, and waist circumference, were measured by trained personnel, and children were asked about whether they usually had the following meals: breakfast, a mid-morning snack, lunch, an afternoon snack, and dinner. Multiple linear regression models revealed a significant (p < 0.05) inverse association between the meal frequency with a standardized BMI (zBMI) and the waist-to-height ratio (WHtR) after adjusting for sex, age, allocation to an intervention group, school, maternal education, physical activity, diet quality, and for the corresponding outcome variable at the baseline. Furthermore, the odds of developing abdominal obesity or excessive weight during the follow-up significantly decreased with an increase in the meal frequency after controlling for the same confounders. In conclusion, a higher meal frequency at the baseline was predictive for a lower zBMI, WHtR, and odds of the incidence of excessive weight and abdominal obesity.

Association between meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents

BACKGROUND

This study aimed to assess the association of meal frequency with anthropometric measures and blood pressure in Iranian children and adolescents.

METHODS

In this national survey, 14,880 students with 6-18 years of age were selected by stratified multistage sampling method from urban and rural regions of 30 provinces of Iran. Meal frequency was assessed by a questionnaire prepared based on global school-based student health survey. Physical measurements included height, weight, waist circumference, systolic blood pressure (SBP), and diastolic blood pressure (DBP).

RESULTS

The participation rate was 90.6% including 49.24% girls and 75.5% urban residents. Skipping breakfast and dinner were more frequent in girls than in boys (71.6% vs. 64.1%, 91.2% vs. 86.9%, respectively, P<0.05). Overweight, obesity, and abdominal obesity were more prevalent in those who had two meals, one meal, or very low intake (P<0.001) than those had three meals. There were no significant differences in SBP, DBP, and blood pressure across to different meal frequency groups (P>0.05). Students who had very low intake and one meal per week had a higher risk of abdominal obesity compared with those who had three meals (OR 1.7, 95% CI: 1.3-2.3, and OR 1.6, 95% CI: 1.4-2.0, respectively).

CONCLUSIONS

An inverse significant association between higher meal frequency and anthropometric indices was observed. Therefore, encouraging children and adolescents for regular meal intake should be considered as a health priority in the pediatric population.

Association between daily eating frequency and mortality in people with diabetes: Findings from NHANES 1999-2014

Background

Previous studies have shown that increasing the frequency of eating is beneficial in terms of cardiovascular metabolic risk factors; however, limited evidence is available for the association between daily eating frequency and mortality, especially in people with diabetes. Therefore, we aimed to explore the association between eating frequency and long-term mortality in populations with diabetes.

Methods

We selected 4,924 individuals suffering from diabetes (mean age: 57.77 years; 51.3% men) from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2014. Daily eating frequency was used as the exposure factor in this study. We extracted the mortality data from the National Death Index records and matched them with the population of NHANES. All participants were followed up from the date of getting enrolled in NHANES to 31 December 2015. Multivariate Cox proportional hazards regression, Kaplan-Meier survival curves, and restricted cubic spline were used to assess the associations between eating frequency and all-cause and cause-specific mortality among people with diabetes.

Results

During 34,950 person-years of follow-up, 1,121 deaths were documented, including 272 cardiovascular disease (CVD)-related deaths and 156 cancer-related deaths. After adjusting for confounding factors, the daily eating frequency was linearly inversely associated with all-cause and CVD-related mortality, and the HR (95% CIs) for per one-time increment of eating frequency was 0.88 (0.80-0.98) and 0.77 (0.63-0.93), respectively. Sensitivity analyses showed that the main results and statistical significance were still stable.

Conclusion

Higher eating frequency was independently related to lower all-cause and CVD-related mortality in people with diabetes, which can be used as a potential strategy for daily-diet management among populations suffering from diabetes.

Joint association of meal frequency and diet quality with metabolic syndrome in Iranian adults

BACKGROUND

Metabolic syndrome (MetS) is a common complication that has been shown in various studies to be related to the frequency and timing of eating. We aimed to evaluate the relationship between meal timing and frequency with diet quality and prevalence of MetS.

STUDY DESIGN

Cross-sectional.

METHODS

We analyzed data from 850 adults (20 to 59 years) and divided the participants into different categories in terms of frequency of eating occasions (EO) (5 ≥ , 6-7 and 7 <), meal (2 ≥ and 3) and snack (2 ≥ , 3 and 4 ≤) in a day. Daily food consumption was assessed using the structured three 24-h recalls. The quality of diet we calculated using the food quality score (FQS). Metabolic syndrome was defined based on the guidelines of the national cholesterol education program adult treatment panel III (ATP III). The covariates-adjusted relationships between exposures and outcomes were investigated using a logistic regression test and two-way ANOVA.

RESULTS

The overall prevalence of MetS in participants was 34.2%. The average FQS was 28.0. Increased frequency of EOs and snacks was related to the higher prevalence of MetS ((OR, 1.72; 95% CI, 1.24, 2.37; P < 0.01) and (OR, 1.34; 95% CI, 1.07, 1.68; P, 0.01), respectively). The adjusted mean of FQS was not significantly different between the EO as well as meals and snack categories. The joint association of EO frequency and snack frequency with diet quality showed a higher chance of having MetS ( (OR, 2.36; 95% CI, 1.19, 4.66; P, 0.01 and (OR, 1.68; 95% CI, 1.06, 2.68; P,0.02), respectively). Also, we observed a higher mean of high density level cholesterol in people with the highest FQS and lowest EO frequency (P,0.02).

CONCLUSION

Our findings suggest that the EO and snack frequency may be associated with the higher chance of MetS. We also found when the frequency of EO increases, the beneficial associations of the diet quality were overshadowed. To confirm our findings, well designed randomised clinical trials are needed.

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.

Eating Speed, Eating Frequency, and Their Relationships with Diet Quality, Adiposity, and Metabolic Syndrome, or Its Components

Excess body weight is a major global health concern, particularly due to its associated increased health risks. Several strategies have been proposed to prevent overweight and obesity onset. In the past decade, it has been suggested that eating speed/rate and eating frequency might be related to obesity. The main aim of this narrative review was to summarize existing evidence regarding the impact of eating speed/rate and eating frequency on adiposity, metabolic syndrome (MetS), or diet quality (DQ). For this purpose, a literature search of observational and interventional trials was conducted between June and September 2020 in PubMed and Web of Sciences databases, without any data filters and no limitations for publication date. Results suggest that children and adults with a faster eating speed/rate may be associated with a higher risk of developing adiposity, MetS or its components. Furthermore, a higher eating frequency could be associated with diet quality improvement, lower adiposity, and lower risk of developing MetS or its components. Further interventional trials are warranted to clarify the mechanism by which these eating behaviors might have a potential impact on health.

Psychological and metabolic risk factors in older adults with a previous history of eating disorder: A cross-sectional study from the Predimed-Plus study

GOALS

To explore affective and cognitive status, later in life, in individuals with and without previous history of eating disorder (ED), and also its association with higher risk for metabolic syndrome (MetS) symptomatology.

METHODS

A cross-sectional analysis of 6756 adults, aged 55-75 years with overweight/obesity and MetS participating in the Predimed-Plus study was conducted. Participants completed self-reported questionnaires to examine lifetime history of ED, according to DSM-5 criteria, and other psychopathological and neurocognitive factors. Anthropometric and metabolic measurements were also collected.

RESULTS

Of the whole sample, 24 individuals (0.35%) reported a previous history of ED. In this subsample, there were more women and singles compared to their counterparts, but they also presented higher levels of depressive symptoms and higher cognitive impairment, but also higher body mass index (BMI) and severe obesity, than those without lifetime ED.

CONCLUSIONS

This is one of the first studies to analyse the cognitive and metabolic impact of a previous history of ED. The results showed that previous ED was associated with greater affective and cognitive impairment, but also with higher BMI, later in life. No other MetS risk factors were found, after controlling for relevant variables.

Timing and Frequency of Daily Energy Intake in Adults with Prediabetes and Overweight or Obesity and Their Associations with Body Fat

Knowledge on how energy intake and macronutrients are distributed during the day and the role of daily eating patterns in body composition among adults with overweight/obesity and prediabetes is lacking. Therefore, we evaluated the diurnal dietary intake and studied the associations of daily eating patterns with body fat percentage. A total of 119 adults with prediabetes were included (mean (SD) HbA_1c 41 (2.3) mmol/mol, BMI 31.5 (5.0) kg/m², age 57.8 (9.3) years, 44% men). Information on dietary intake was obtained from self-reported food records for three consecutive days. All foods and beverages (except water) were registered with information on time of ingestion. Body fat was measured by dual-energy X-ray absorptiometry. A total of 60.5% of the participants reported a daily eating window of 12 or more hours/day, and almost half of the daily total energy intake was reported in the evening. In analyses adjusted for age, gender, and total daily energy intake, having the first daily energy intake one hour later was associated with slightly higher body fat percentage (0.64% per hour, 95% CI: 0.28; 1.01; p < 0.001), whereas higher meal frequency was associated with slightly lower body fat percentage (0.49% per extra daily meal, 95% CI: −0.81; −0.18; p = 0.002). Prospective studies are warranted to address the clinical implications of daily eating patterns on body fat and cardiometabolic health.

Snacking may improve dietary fiber density and is associated with a lower body mass index in postmenopausal women

OBJECTIVES

This study aimed to examine the relationship between eating frequency (EF), meal frequency, and snacking frequency (SF), and the body weight status of postmenopausal women. We tested how meal frequency and SF were related with macronutrient intake, and how different definitions of snacking affected the study results.

METHODS

Dietary intake was assessed using a 3-d food diary in 302 women age 45 to 65 y. Body weight, body fat percentage, and waist circumference were measured, and the body mass index (BMI) was computed. Women were classified as overweight-to-obese or of normal weight. Eating occasions that provided at least 50 kcal were classified as meals or snacks based on three definitions: Contribution to total energy intake (EI; ≥15% as a meal, <15% as a snack), self-reported, and based on time.

RESULTS

When adjusted for confounders and the EI:estimated energy requirement, a negative association was seen between EF, self-reported SF, and BMI. EF and self-reported SF were negatively associated with EI. Differences in the dietary composition of the snacks between the groups were seen when identified by participants themselves. Specifically, the percentage energy from total sugar and alcohol in self-reported snacks was significantly lower, but dietary fiber density was significantly higher among normal-weight compared with overweight-to-obese women.

CONCLUSIONS

Higher EF and self-reported SF, independently of the EI:estimated energy requirement, is associated with lower BMI values and EI in postmenopausal women. Snacking may improve the dietary fiber density of the diet. An objective definition of snacking needs to be used in nutritional studies.

Daily Eating Frequency in US Adults: Associations with Low-Calorie Sweeteners, Body Mass Index, and Nutrient Intake (NHANES 2007-2016)

Studies of relationships between eating frequency and/or timing and energy intake have not examined associations with low-calorie sweeteners (LCS). We assessed the frequency of eating behavior related to LCS consumption emphasizing timing, calorie intake, and body mass index (BMI) among United States (US) adults aged ≥19 years. Using the National Health and Nutrition Examination Survey (NHANES) 2007-2016, we defined eating episodes as food and/or beverage intake within 15 min of one another over the first 24-h dietary recall. We coded items ingested during episodes (n = 136,938) and assessed LCS presence using US Department of Agriculture (USDA) food files. Episode analysis found intakes of foods only (27.4%), beverages only (29.5%), and foods with beverages (43.0%). LCS items were consumed without concurrent calories from other sources in fewer than 2.7% of all episodes. Within participants having normal weight (29.4%), overweight (33.6%) and obese (37.1%) BMIs, LCS consumers (35.2% overall) evidenced: more episodes/day; and fewer: calories, carbohydrates, fats, and protein per episode. Per person, those consuming LCS had lower total calories and higher fiber intake per day. LCS consumption was associated with higher BMI. Number of eating episodes/day and longer hours when eating episodes occurred were also consistently associated with higher BMI. Consuming LCS did not modify these relationships. These results did not show that LCS consumption was associated with increased caloric intake from other dietary sources.

Examination of different definitions of snacking frequency and associations with weight status among U.S. adults

Snacks, while widely consumed in the United States (U.S.), do not have a standard definition, complicating research to understand associations, if any, with weight status. Therefore, the purpose of this study was to examine the association between snacking frequency and weight status using various snacking definitions that exist in the scientific literature among U.S. adults (NHANES 2013–2016; ≥20y n = 9,711). Four event-based snacking definitions were operationalized including participant-defined snacks, eating events outside of meals, and operationally defined snacks based on absolute thresholds of energy consumed (>50 kcal). Weight status was examined using body mass index (BMI), waist circumference, and sagittal abdominal diameter risk. Logistic regression models examined snacking frequency and associations with weight status. Outcomes varied by the definition of a snack employed, but the majority of findings were null. Mean energy from snacks was significantly higher among women with obesity compared to women with normal weight when a snack was defined as any event outside of a typical mealtime (i.e. other than breakfast, lunch, dinner, super, brunch), regardless of whether or not it contributed ≥50 kcal. Further investigation into ingestive behaviors that may influence the relationship between snacking frequency and weight status is needed.

Diet-Related Factors, Physical Activity, and Weight Status in Polish Adults

Obesity is a serious problem for both the individual and society due to its health and economic consequences. Therefore, there is a need to focus on factors which explain this phenomenon and may be useful in preventing future occurrence. The aim of this study was to determine the lifestyle factors coexisting with increased body mass index (BMI ≥ 25 kg/m²) in Polish adults, including factors related to diet (dietary patterns-DPs; dietary restrictions; number of meals; frequency of snacking, eating out, and ordering home delivery meals), physical activity, and sociodemographic characteristics. A cross-sectional quantitative survey was carried out in 2016 amongst 972 Polish adults under the Life Style Study (LSS). To determine the factorscoexisting with BMI ≥ 25 kg/m², the logistic regression model was developed. Women were less likely to be overweight or obese compared to men. The likelihood of BMI ≥ 25 kg/m² increased with age by 4% in each subsequent year of life. Frequent consumption of fruits and vegetables, adhering to restrictions in quantity of food consumed and at least moderate physical activity during leisure time decreased the likelihood of BMI ≥ 25 kg/m². More frequent consumption of meat and eating five or more meals a day increased the likelihood of BMI ≥ 25 kg/m². Diet-related factors explained the developed model better than factors related to physical activity, however, age and gender were the factors most strongly correlated with BMI ≥ 25 kg/m². Therefore, development of strategies to prevent and reduce overweight and obesity should focus on the demographic characteristics of the population, and then on teaching behaviors conducive for reducing the amount of food consumed, especially meat. However, physical activity in leisure time should also be included in the prevention of obesity.

The influence of identity on the prevalence and persistence of disordered eating and weight control behaviors in Mexican American college women

Disordered eating behaviors are prevalent in Mexican-American college-enrolled women and contribute to compromised physical and psychological health. Although disordered eating behaviors are multi-determined, few studies have examined individual difference factors that contribute to disordered eating behaviors in Mexican women beyond acculturation. Evidence suggests that individual differences in the constellation of identities may be an important factor influencing the disordered eating behaviors. We hypothesized that individual differences in the collection of identities (self-schemas) increases susceptibility to defining oneself as fat (fat self-schema) and contribute to disordered eating behaviors over time in Mexican American college women. A 12-month longitudinal design was used to measure the level of disordered eating behaviors at 5 points over 12 months in 477 Mexican American women. Identity properties (i.e., positive self-schemas, negative self-schemas, fat self-schema) were measured at baseline. Controlling for relevant covariates, latent growth curve models showed that Mexican American women with few positive and many negative self-schemas were more likely to define themselves as fat, which in turn, predicted purging and fasting/restricting behaviors across the year. However, identity properties were not predictive of binge eating and excessive exercise episodes. Interventions focused on development of positive self-schemas that reflect areas of interest and competence and the revision of negative self-schemas may protect against purging and fasting/restricting in Mexican American college-enrolled women.

A Novel Automated System Yields Reproducible Temporal Feeding Patterns in Laboratory Rodents

BACKGROUND

The impact of temporal feeding patterns remains a major unanswered question in nutritional science. Progress has been hampered by the absence of a reliable method to impose temporal feeding in laboratory rodents, without the confounding influence of food-hoarding behavior.

OBJECTIVE

The aim of this study was to develop and validate a reliable method for supplying crushed diets to laboratory rodents in consistent, relevant feeding patterns for prolonged periods.

METHODS

We programmed our experimental feeding station to deliver a standard diet [StD; Atwater Fuel Energy (AFE) 13.9% fat] or high-fat diet (HFD; AFE 45% fat) during nocturnal grazing [providing 1/24th of the total daily food intake (tdF/I) of ad libitum-fed controls every 30 min] and meal-fed (3 × 1-h periods of ad libitum feeding) patterns in male rats (Sprague-Dawley: 4 wk old, 72-119 g) and mice [C57/Bl6J wild-type (WT): 6 mo old, 29-37 g], and ghrelin-null littermates (Ghr-/-; 27-34 g).

RESULTS

Grazing yielded accurate, consistent feeding events in rats, with an approximately linear rise in nocturnal cumulative food intake [tdF/I (StD): 97.4 ± 1.5% accurate compared with manual measurement; R2 = 0.86; tdF/I (HFD): 99.0 ± 1.4% accurate; R2 = 0.86]. Meal-feeding produced 3 nocturnal meals of equal size and duration in StD-fed rats (tdF/I: 97.4 ± 0.9% accurate; R2 = 0.90), whereas the second meal size increased progressively in HFD-fed rats (44% higher on day 35 than on day 14; P < 0.01). Importantly, cumulative food intake in grazing and meal-fed rats was identical. Similar results were obtained in WT mice except that less restricted grazing induced hyperphagia (compared with meal-fed WT mice; P < 0.05 from day 1). This difference was abolished in Ghr-/- mice, with meal initiation delayed and meal duration enhanced. Neither pattern elevated corticosterone secretion in rats, but meal-feeding aligned ultradian pulses.

CONCLUSIONS

We have established a consistent, measurable, researcher-defined, stress-free method for imposing temporal feeding patterns in rats and mice. This approach will facilitate progress in understanding the physiologic impact of feeding patterns.

Eating frequency is inversely associated with BMI, waist circumference and the proportion of body fat in Korean adults when diet quality is high, but not when it is low: analysis of the Fourth Korea National Health and Nutrition Examination Survey (KNHANES IV)

The role of eating frequency (EF) in obesity development has been debated, and few studies have investigated Asian populations. Diet quality might affect the association between EF and obesity. Therefore, we investigated the association between EF and obesity indicators in a representative sample of Korean adults with consideration to diet quality. This cross-sectional study used data of 6951 participants aged 19-93 years (male 49·8 %, female 50·2 %) from the Fourth Korean National Health and Nutrition Examination Survey. EF was assessed using a questionnaire, and diet quality was defined as mean adequacy ratio (MAR). To explore the association between EF and obesity indicators, we used multiple linear regression analyses with and without interaction terms between diet quality and EF. EF was inversely associated with each obesity indicator, including body fat percentage (BF%), BMI and waist circumference (WC), showing a significant linear trend (P<0·001 for BF%, WC and BMI). In addition, the association between EF and each obesity indicator was significantly altered according to diet quality (P value of the interaction term EF×diet quality=0·008 in the regression model for BF%, <0·001 for BMI and 0·043 for WC). In the stratified analyses according to diet quality, EF had a significant inverse association with BF%, WC and BMI in the high diet quality groups, but not in the low diet quality groups. This study suggests that EF is inversely associated with the obesity indicators when diet quality is high, but not when it is low in Korean adults.

Association between Eating Speed and Classical Cardiovascular Risk Factors: A Cross-Sectional Study

Cardiovascular disease (CVD) is one of the main causes of morbidity and mortality around the world. Lifestyle is recognized as a key factor in the development of metabolic disorders and CVD. Recently, eating speed has been of particular interest since some studies have associated it with the development of obesity and other cardiometabolic disorders. We aimed to assess the association between eating speed and various cardiovascular risk factors. We conducted a cross-sectional analysis within the framework of the PREDIMED (Prevención con Dieta Mediterránea) study with 792 participants from the Reus-Tarragona center. Eating speed was self-reported according to participant perception and categorized as slow, medium, or fast. The association between eating speed and cardiovascular risk factors was assessed using Cox regression models with constant time of follow-up for all individuals. Compared to participants in the slow eating speed category, those in the faster eating speed category were 59% more likely to have the hypertriglyceridemia component of the metabolic syndrome (MetS) (Hazard Ratio, (HR) 1.59; 95% Confidence Interval (CI) 1.16–2.17), even after adjustment for potential confounders (HR 1.47; 95% CI 1.08–2.02). No other significant differences were observed. Eating speed was positively associated with the prevalence of the hypertriglyceridemia component of the MetS in a senior population at high cardiovascular risk.

Eating Frequency Is Not Associated with Obesity in Chinese Adults

The prevalence of overweight and obesity has been increasing globally. Recent studies suggest that eating frequency (EF) might be a factor influencing the development of overweight and obesity. This study aims to explore the association between eating frequency and obesity in Chinese adults. A cross-sectional study was conducted in Wuhan, China, from March to June 2016. A self-administered questionnaire and 24-h dietary recall were used to collect data on sociodemographic variables, lifestyle factors, nutrition knowledge, and eating frequency. Participants were divided into four groups according to eating frequency and meal timing: traditional time pattern (TTP), traditional time plus late snack pattern (TTLSP), irregular time pattern (ITP), and all-day pattern (ADP). We performed the chi-squared test and multiple logistic regression to assess associations among variables using JMP statistical software version 14.0.0 (SAS Institute Inc., Cary, NC, USA). Respondents were Chinese adults (N = 2290; range 29⁻74 years; 1162 men). Lower education level, higher food budget, and lower nutrition knowledge were associated with higher likelihood of irregular EF patterns (TTLSP, ITP, or ADP). Men, non-smokers, and participants with less physical activity, lower education level, or lower nutrition knowledge were more likely to be obese. Body mass index (BMI) categorization was significantly different among EF pattern groups (χ² = 25.40, p = 0.003); however, this association was no longer significant in the regression model after adjustment for age, sex, education, smoking, food budget, nutrition knowledge, and physical activity. Thus, EF is not associated with obesity in Chinese adults.

Snack cost and percentage of body fat in Chinese children and adolescents: a longitudinal study

PURPOSE

Only a few studies examined the relationship between snack cost and change in the percentage of body fat in children. We thus conducted a longitudinal study to investigate whether high snack cost is associated with fast increase in the percentage of body fat in Chinese children.

METHODS

The study included 2368 children (1126 girls and 1242 boys, aged 6-14 years). Percentage of body fat was repeatedly assessed by bioelectrical impedance analysis in 2014 (baseline), 2015 and 2016. Snack cost in 2014 was estimated by self-report associated with purchasing snacks at school and classified into low, moderate, and high group. Association between snack cost and repeated percentage of body fat was analyzed with linear mixed models, adjusting for demographic factors, diet, physical activity, and parental BMI and education.

RESULTS

High snack cost was significantly associated with a fast increase in the percentage of body fat over time (p trend = 0.04). Adjusted difference in annual increase rate in percentage of body fat between the high and low snack cost group was 0.31% [95% confident interval (CI) 0.04%, 0.58%], after adjusting for potential confounders. The impacts of snack cost on change in the percentage of body fat were more pronounced in boys, younger participants and those with higher BMI z-score at the baseline, relative to their counterparts (p interaction < 0.001 for all).

CONCLUSIONS

High snack cost was associated with more gain of body fat in Chinese school-aged children.

The benefits of defining "snacks"

Whether eating a "snack" is considered a beneficial or detrimental behavior is largely based on how "snack" is defined. The term "snack food" tends to connote energy-dense, nutrient-poor foods high in nutrients to limit (sugar, sodium, and/or saturated fat) like cakes, cookies, chips and other salty snacks, and sugar-sweetened beverages. Eating a "snack food" is often conflated with eating a "snack," however, leading to an overall perception of snacks as a dietary negative. Yet the term "snack" can also refer simply to an eating occasion outside of breakfast, lunch, or dinner. With this definition, the evidence to support health benefits or detriments to eating a "snack" remains unclear, in part because relatively few well-designed studies that specifically focus on the impact of eating frequency on health have been conducted. Despite these inconsistencies and research gaps, in much of the nutrition literature, "snacking" is still referred to as detrimental to health. As discussed in this review, however, there are multiple factors that influence the health impacts of snacking, including the definition of "snack" itself, the motivation to snack, body mass index of snack eaters, and the food selected as a snack. Without a definition of "snack" and a body of research using methodologically rigorous protocols, determining the health impact of eating a "snack" will continue to elude the nutrition research community and prevent the development of evidence-based policies about snacking that support public health.

Decreased eating frequency linked to increased visceral adipose tissue, body fat, and BMI in Hispanic college freshmen

Background

To investigate the relationship between eating frequency and specific adiposity markers in a potentially high-risk and understudied population of Hispanic college freshmen.

Methods

This study included 92 Hispanic college freshmen (18–19 y). The following cross-sectional data were collected: height, weight, waist circumference, body mass index (BMI), dietary intake, body composition, physical activity, hepatic fat, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT).

Results

Infrequent eaters ate 44% less often (2.5 ± 0.2 vs. 4.5 ± 0.8, p ≤ 0.01) and consumed 27% more calories per EO (p ≤ 0.01), while consuming 21% less kcals per day (p ≤ 0.01) compared to frequent eaters. Infrequent eaters had 8% higher BMIs (24.8 ± 4.4 vs. 22.9 ± 3.2 kg/m²) (p = 0.02), 60% higher BMI z-scores (0.5 ± 1.0 vs. 0.2 ± 1.0, p = 0.03), 21% higher VAT (298.3 ± 153.8 vs. 236.8 ± 78.2 ml, p = 0.03), 26% higher SAT (1150.1 ± 765.4 vs. 855.6 ± 494.6 ml, p = 0.03), and 8% higher total body fat (27.6 ± 10.8 vs. 25.3 ± 8.8%, p = 0.04) compared to frequent eaters while showing no significant difference in physical activity. These findings seem to be driven by females more than males.

Conclusions

These findings suggest that infrequent eating is related to increased adiposity in Hispanic college freshmen, despite a decreased daily energy intake and no significant differences in physical activity. Yet, more research is needed to understand the underlying mechanisms of these findings, as well as investigate any potential causal relationship between eating frequency and adiposity in Hispanic youth.

Snacking Recommendations Worldwide: A Scoping Review

Across the globe, dietary habits include the consumption of foods and drinks between main meals. Although often described as "snacks" or "snacking," there is no scientific consensus of what constitutes a snack, either as an eating occasion or as a snack food. Nonetheless, food-based dietary guidelines, compiled at national or regional levels by governments, learned societies, and health organizations, frequently refer to snacking habits and desirable or undesirable snack food choices. This review aims to provide a comprehensive snapshot of snacking recommendations worldwide. From a search of 207 countries and organizations, 49 countries and 7 regional or global organizations were identified that referred to snacks, snack foods, or snacking. A total of 136 snacking-specific recommendations or examples were identified, which varied in nature whereby some provided advice on the quality of the snack food choice and others focused on the frequency or energy and nutrient composition of such snacks. Guidelines varied in terms of the detail of foods and drinks identified, wherein some recommendations focused only on foods or food categories to include (e.g., fruit or dairy) or to exclude (e.g., processed foods), whereas other recommendations made reference to both. Both individual foods (e.g., apples) and food categories (e.g., fruit) were mentioned. Reasons or rationales to support the snacking choices were less frequently identified and varied across regions. It is hoped that this analysis will stimulate discussion on the need for a consensus in the scientific community and beyond with regard to snacking. An agreed-upon definition of snacks, snacking, and snack foods could be used to inform a number of stakeholders and ultimately help consumers adhere to healthful diets as defined locally.

Associations between nutritional quality of meals and snacks assessed by the Food Standards Agency nutrient profiling system and overall diet quality and adiposity measures in British children and adolescents

OBJECTIVE

This cross-sectional study examined how the nutritional quality of meals and snacks was associated with overall diet quality and adiposity measures.

METHODS

Based on 7-d weighed dietary record data, all eating occasions were divided into meals or snacks based on time (meals: 06:00-09:00 h, 12:00-14:00 h, and 17:00-20:00 h; snacks: others) or contribution to energy intake (meals: ≥15%; snacks: <15%) in British children aged 4-10 (n = 808) and adolescents aged 11-18 (n = 809). The nutritional quality of meals and snacks was assessed as the arithmetical energy intake-weighted means of the Food Standards Agency (FSA) nutrient profiling system score of each food and beverage consumed, based on the contents of energy, saturated fatty acid, total sugar, sodium, fruits/vegetables/nuts, dietary fiber, and protein.

RESULTS

Regardless of the definition of meals and snacks, higher FSA score (lower nutritional quality) of meals was inversely associated with overall diet quality assessed by the Mediterranean diet score in both children and adolescents (P <0.0001), whereas the inverse associations for the FSA score of snacks did not reach statistical significance. The FSA score of meals based on time was inversely associated with body mass index z-score only in children, whereas that of snacks based on time showed a positive association.

CONCLUSION

Lower nutritional quality of meals, but not snacks, assessed by the FSA score was associated with lower overall diet quality, whereas no consistent associations were observed with regard to adiposity measures.

Eating frequency predicts changes in regional body fat distribution in healthy adults

BACKGROUND

Eating frequency (EF) has been associated with generalized obesity.

AIM

We aimed to prospectively investigate potential associations of frequency of eating episodes with regional fat layers.

DESIGN

EF was evaluated at baseline in 115 subjects free of clinically overt cardiovascular disease (54 ± 9.1 years, 70 women) in a prospective, observational study.

METHODS

Metabolic parameters known to be associated with dietary factors and anthropometric markers including ultrasound assessment of subcutaneous (Smin) and pre-peritoneal (Pmax) fat and their ratio Smin/Pmax (AFI) were evaluated at baseline and at follow-up, 5 years later.

RESULTS

EF at baseline positively correlated with Pmax, even after adjustment for potential confounders. EF above median was also an independent predictor for Pmax (beta coefficient = -0.192, P = 0.037) and AFI (beta coefficient = 0.199, P = 0.049) at follow up. Multivariable linear mixed models analysis demonstrated that subjects with increased EF presented a lower progression rate of Pmax (beta = -0.452, P = 0.006) and a higher progression rate of AFI (beta = 0.563, P = 0.003) over time, independently of age, sex, progression of BMI, energy intake, smoking and changes in parameters of glucose metabolism.

CONCLUSIONS

High EF is associated with lower progression rate of pre-peritoneal fat accumulation. Future interventional studies should further investigate the clinical utility of these findings.

Nutritional quality of meals and snacks assessed by the Food Standards Agency nutrient profiling system in relation to overall diet quality, body mass index, and waist circumference in British adults

BACKGROUND

Studies examining meal and snack eating behaviors in relation to overall diet and health markers are limited, at least partly because there is no definitive consensus about what constitutes a snack, a meal, or an eating occasion. This cross-sectional study examined how nutritional quality of meals and snacks is associated with overall diet quality, body mass index (BMI), and waist circumference.

METHODS

Based on 7-d weighed dietary record data, all eating occasions were divided into meals or snacks based on time (meals: 0600-1000, 1200-1500, and 1800-2100 h; snacks: others) or contribution to energy intake (EI) (meals: ≥15%; snacks: <15%) in 1451 British adults aged 19-64 years participating in the National Diet and Nutrition Survey. Nutritional quality of meals and snacks was assessed as the arithmetic EI-weighted means of the British Food Standards Agency (FSA) nutrient profiling system score of each food and beverage consumed, based on the contents of energy, saturated fatty acid, total sugar, sodium, fruits/vegetables/nuts, dietary fiber, and protein per 100 g.

RESULTS

Irrespective of the definition of meals and snacks, higher FSA scores (lower nutritional quality) of both meals and snacks were associated with unfavorable profiles of individual components of overall diet, including lower intakes of fruits/vegetables/nuts and higher intakes of biscuits/cakes/pastries, total fat, and saturated fatty acid. The FSA scores of meals and snacks were also inversely associated with overall diet quality assessed by the healthy diet indicator (regression coefficient (β) = -0.22 to -0.17 and -0.06 to -0.03, respectively) and Mediterranean diet score (β = -0.25 to -0.19 and -0.08 to -0.05, respectively) in both sexes (P ≤ 0.005). However, the associations were stronger for meals, mainly due to their larger contribution to total EI (64% to 84%). After adjustment for potential confounders, only the FSA score of snacks based on EI contribution was positively associated with BMI and waist circumference in women (P ≤ 0.005).

CONCLUSIONS

Although lower nutritional quality of both meals and snacks assessed by the FSA score was associated with adverse profiles of overall diet quality (but not necessarily adiposity measures), stronger associations were observed for nutritional quality of meals.

Longitudinal associations of away-from-home eating, snacking, screen time, and physical activity behaviors with cardiometabolic risk factors among Chinese children and their parents

Background: Little is known about intergenerational differences in associations of urbanization-related lifestyle behaviors with cardiometabolic risk factors in children and their parents in rapidly urbanizing China.Objective: We tested the intergenerational differences in longitudinal associations of away-from-home eating, snacking, screen time, and leisure-time sports with high waist-to-height ratio (WHtR), elevated blood pressure (BP), elevated glycated hemoglobin (HbA1c), and elevated C-reactive protein (CRP) among Chinese children and their parents.Design: We studied children enrolled in the longitudinal China Health and Nutrition Survey (1991-2009, 7 surveys) aged 7-17 y in ≥2 surveys (average follow-up: 2.3 surveys out of a possible 4 surveys with the age restriction; n = 3875, including 1175 siblings) and their parents (2947 mothers, 2632 fathers) living in the same household. We used 3 consecutive interviewer-administered 24-h dietary recalls to derive a 3-d average for away-from-home eating (nonconsumer, >0 and <1 meal/d, or ≥1 meals/d) and consumption of fruit or vegetable snacks (any or none) and other snacks (any or none) and a self-reported 7-d physical activity recall for screen time (≤1, >1 and ≤2, or >2 h/d) and leisure-time sports (any or none). Random-effects logistic regression was used to examine the associations of lagged (average: 3 y) behaviors with cardiometabolic risk factors (WHtR, BP, HbA1c, and CRP).Results: We detected intergenerational differences in associations between lagged behaviors and risk factors (P-interaction < 0.1). Generation-specific models showed that lagged away-from-home eating of ≥1 meal/d (compared with none) was negatively associated with parents' high WHtR (OR: 0.68; 95% CI: 0.53, 0.88) but positively associated with children's high WHtR (OR: 1.46; 95% CI: 1.01, 2.12). Lagged fruit and vegetable snack consumption was negatively related to parents' (OR: 0.76; 95% CI: 0.59, 0.97) and children's (OR: 0.58; 95% CI: 0.33, 1.00) high WHtR. Lagged screen time (>2 compared with ≤1 h/d) was positively associated with parents' (OR: 2.58; 95% CI: 1.56, 4.28) and children's high WHtR (OR: 2.26; 95% CI: 1.06, 4.83).Conclusion: Parent-offspring differences in associations between lifestyle behaviors and cardiometabolic risk factors provide insight into intergenerational differences in cardiometabolic risk with urbanization.

The Association of Dietary Behaviors and Physical Activity Levels with General and Central Obesity among ASEAN University Students

Objective

To quantify the prevalence of obesity and obesity-related factors (dietary behaviors and physical activity levels) in a cross-sectional, observational study of ASEAN undergraduate students.

Material and Methods

A total of 6783 (35.5% male and 64.5% female) undergraduate students (Mean age: 20.5, SD = 2.0) from eight ASEAN countries completed questionnaires and anthropometric measurements. Multivariable logistic regression was used to estimate odds ratios (ORs) for the association of nutrition behaviors with prevalence of general obesity (body mass index ≥ 25 kg/m²), elevated waist-to-height ratio (WHtR) (>0.50), and high waist circumference (WC) (≥80 cm in females, ≥90 cm in males). Covariates included sociodemographic factors, dietary behavior, physical activity and sitting time (using the “International Physical Activity Questionnaire”).

Results

There was a higher prevalence of general obesity (24.2% versus 9.3%), and high WHtR (16.6% versus 12.1) in males relative to females, while high WC (9.4% versus 10.4%) did not significantly differ between genders. In multivariable logistic regression analyses, compared to females, males had higher odds of obesity (odds-ratio, OR: 2.13, confidence interval, CI: 1.80, 2.77), and high WHtR (OR: 1.90, CI: 1.48, 2.43) (P < 0.001 for both). Snacking frequency and avoiding fatty foods were associated with all three obesity indicators; obesity (OR: 1.16, CI: 1.05, 1.28 and OR: 1.54, CI: 1.24, 1.92, respectively), WHtR (OR: 1.17, CI: 1.04, 1.32 and OR: 1.46, CI: 1.04, 1.54), and high WC (OR: 1.16, CI: 2.01, 1.33 and OR 1.52, CI: 1.14, 2.04, respectively). Physical activity and sedentary behavior were not significantly associated with any obesity measure.

Conclusions

There was a low prevalence of healthy behaviors and a high prevalence of obesity in this sample of ASEAN young adults. Specific dietary behaviors but not physical activity nor sedentary behavior were associated with obesity.

Associations between energy density of meals and snacks and overall diet quality and adiposity measures in British children and adolescents: the National Diet and Nutrition Survey

This cross-sectional study examined how energy density (ED) of meals and snacks are associated with overall diet quality and adiposity measures in 1617 British children aged 4-18 years from the 1997 National Diet and Nutrition Survey. On the basis of data from 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of time (meals: 06.00-09.00, 12.00-14.00 and 17.00-20.00 hours; snacks: all others) or contribution to energy intake (EI) (meals: ≥15 %; snacks: <15 %). ED of meals and snacks was calculated on the basis of food only. Overall diet quality was assessed using the Mediterranean diet score (range 0-8). Irrespective of the definition of meals and snacks, ≥67 % of EI was derived from meals, whereas ED of meals was lower than ED of snacks (mean: 8·50-8·75 v. 9·69-10·52 kJ/g). Both ED of meals and ED of snacks were inversely associated with total intakes of vegetables, fruits, dietary fibre and overall diet quality and positively associated with total intakes of fat. However, the associations were stronger for ED of meals. The change in the Mediterranean diet score with a 1-unit increase of ED (kJ/g) was -0·35 to -0·30 for ED of meals and -0·09 to -0·06 for ED of snacks (all P<0·0001). After adjustment for potential confounders, all measures of ED of meals and snacks did not show positive associations with adiposity measures. In conclusion, although both ED of meals and ED of snacks were associated with adverse profiles of overall diet quality (but not adiposity measures), stronger associations were observed for ED of meals.

Eating frequency in relation to BMI in very young children: a longitudinal analysis

OBJECTIVE

Eating less frequently is associated with increased obesity risk in older children but data are potentially confounded by reverse causation, where bigger children eat less often in an effort to control their weight. Longitudinal data, particularly in younger children, are scarce. We aimed to determine whether eating frequency (meals and snacks) at 2 years of age is associated with past, current or subsequent BMI.

DESIGN

Cohort analysis of a randomised controlled trial. Eating frequency at 2 years of age was estimated using 48 h diaries that recorded when each child ate meals and snacks (parent-defined) in five-minute blocks. Body length/height and weight were measured at 1, 2 and 3·5 years of age. Linear regression assessed associations between the number of eating occasions and BMI Z-score, before and after adjustment for potential confounding variables.

SETTING

Prevention of Overweight in Infancy (POI) study, Dunedin, New Zealand.

SUBJECTS

Children (n 371) aged 1-3·5 years.

RESULTS

On average, children ate 5·5 (sd 1·2) times/d at 2 years of age, with most children (88-89 %) eating 4-7 times/d. Eating frequency at 2 years was not associated with current (difference in BMI Z-score per additional eating occasion; 95 % CI: -0·02; -0·10, 0·05) or subsequent change (0·02; -0·03, 0·06) in BMI. Similarly, BMI at age 1 year did not predict eating frequency at 2 years of age (difference in eating frequency per additional BMI Z-score unit; 95 % CI: -0·03; -0·19, 0·13).

CONCLUSIONS

Number of eating occasions per day was not associated with BMI in young children in the present study.

Factors related to obesity and overweight among Black adolescent girls in the United States

In the United States, Black adolescents have the highest prevalence of pediatric obesity and overweight among girls. While Black girls are disproportionately affected, the reasons for this health disparity remain unclear. The authors conducted a systematic review to investigate the factors related to obesity and overweight among Black adolescent girls. The authors searched four databases for relevant English-language publications using all publication years through 2015. Fifty-one studies met the inclusion criteria and were used for this review. Using a configuration approach to synthesis, three categories were identified, paralleling the bioecological theory of human development: (1) individual, (2) interpersonal, and (3) community and societal factors. A description of each factor's association with obesity among Black adolescent girls is presented. From this review, the authors identified a diverse and vast set of individual, interpersonal, and community and societal factors explored for their relationship with obesity and overweight. Given the insufficient repetition and limited significant findings among most factors, the authors believe that multiple gaps in knowledge exist across all categories regarding the factors related to obesity and overweight among Black adolescent girls. To improve the quality of research in this area, suggested research directions and methodological recommendations are provided.

Meal Timing and Frequency: Implications for Cardiovascular Disease Prevention: A Scientific Statement From the American Heart Association

Eating patterns are increasingly varied. Typical breakfast, lunch, and dinner meals are difficult to distinguish because skipping meals and snacking have become more prevalent. Such eating styles can have various effects on cardiometabolic health markers, namely obesity, lipid profile, insulin resistance, and blood pressure. In this statement, we review the cardiometabolic health effects of specific eating patterns: skipping breakfast, intermittent fasting, meal frequency (number of daily eating occasions), and timing of eating occasions. Furthermore, we propose definitions for meals, snacks, and eating occasions for use in research. Finally, data suggest that irregular eating patterns appear less favorable for achieving a healthy cardiometabolic profile. Intentional eating with mindful attention to the timing and frequency of eating occasions could lead to healthier lifestyle and cardiometabolic risk factor management.

Parent-adolescent influences on everyday dietary practices: Perceptions of adolescent females with obesity and their mothers

Parents demonstrate an important influence on adolescent obesity and dietary behavior; yet, family-based obesity interventions continue to exhibit limited success among adolescents. To further inform family-based approaches for adolescent obesity treatment, we examined the perceptions of adolescent females with obesity and their mothers of the influences experienced within the parent-adolescent relationship that affect everyday dietary practices. We conducted six focus group interviews (three adolescent female and three mother) among 15 adolescent (12-17 years old) females with obesity and 12 of their mothers. Content analysis techniques were used to analyze the transcribed interviews. Adolescent females with obesity discussed a diverse set of parental influences (controlling, supporting and cultivating, overlooking and tempting, acquiescing, providing, attending, and not providing and avoiding) on their daily dietary practices. Among mother focus groups, mothers discussed specific intentional and unintentional types of influences from children that affected the food and drink they consumed, prepared, and acquired. Findings provide a fuller view of the varied social influences on everyday dietary practices within the parent-adolescent relationship. They indicate the importance of examining both parent-to-child and child-to-parent influences and begin to illuminate the value of attending to the social circumstances surrounding dietary behaviors to strengthen family-based obesity treatment approaches.

Daily meal frequency and associated variables in children and adolescents

OBJECTIVE

To investigate the frequency distribution of daily meals and its relation to demographic, socioeconomic, behavioral, anthropometric and biochemical factors in children and adolescents.

METHODS

This was a cross-sectional study with a representative sample of 708 schoolchildren aged 7-14 years. Data on personal information, socioeconomic status, physical activity and number of meals were obtained through semi-structured questionnaire and consumption by 24-h recall and food record. Weight and height measurements were also performed to calculate the body mass index. Finally, blood samples were collected for analysis of total cholesterol, high- and low density lipoprotein, triglyceride, and glucose levels. Descriptive statistics, the Mann-Whitney test, and Poisson regression were used in statistical analysis.

RESULTS

Meal frequency <4 was associated in children, family income <3 Brazilian minimum wages (PR=5.42; 95% CI: 1.29-22.77; p=0.021) and adolescents, the number of sons in the family >2 (PR=1.53; 95% CI: 1.11-2.11; p=0.010). Even in the age group of 10-14 years, <4 meals was related to higher prevalence of body mass index (PR=1.33; 95% CI: 1.02-1.74; p=0.032) and low-density lipoprotein (PR=1.39; 95% CI: 1.03-1.87; p=0.030) higher after adjustments.

CONCLUSION

Lower frequency of meals was related to lower income in children and adolescents, larger number of sons in the family, and increased values of body mass index and low-density lipoprotein.

Energy density of meals and snacks in the British diet in relation to overall diet quality, BMI and waist circumference: findings from the National Diet and Nutrition Survey

This cross-sectional study examined how energy density (ED) in meals and snacks is associated with overall diet quality, BMI and waist circumference (WC). On the basis of the data from 7-d weighed dietary record, all eating occasions were divided into meals or snacks based on time (meals: 06.00-10.00, 12.00-15.00 and 18.00-21.00 hours; snacks: others) or contribution to energy intake (EI) (meals: ≥15; snacks: <15%) in 1451 British adults aged 19-64 years. Irrespective of the definition of meals and snacks, both meal ED and snack ED (kJ/g; calculated on the basis of solid food only) were inversely associated with overall diet quality assessed by the healthy diet indicator (regression coefficient (β)=-0·29 to -0·21 and -0·07 to -0·04, respectively) and Mediterranean diet score (β=-0·43 to -0·30 and -0·13 to -0·06, respectively) in both sexes (P≤0·002), although the associations were stronger for meal ED. After adjustment for potential confounders, in both men and women, meal ED based on EI contribution showed positive associations with BMI (β=0·34; 95% CI 0·06, 0·62 and β=0·31; 95% CI 0·01, 0·61, respectively) and WC (β=0·96; 95% CI 0·27, 1·66 and β=0·67; 95% CI 0·04, 1·30, respectively). In addition, meal ED based on time was positively associated with WC in men (β=0·59; 95% CI 0·07, 1·10) and snack ED based on time was positively associated with BMI in women (β=0·15; 95% CI 0·04, 0·27). In analyses in which only acceptable EI reporters were included, similar results were obtained. In conclusion, the findings suggest stronger associations of meal ED with overall diet quality, BMI and WC compared with snack ED.

Breakfast consumption and adiposity among children and adolescents: an updated review of the literature

BACKGROUND

Breakfast consumption has been associated with reduced risk of overweight and obesity among children, but previous evidence reviews fail to confirm a causal relationship.

OBJECTIVES

To review recent literature on breakfast consumption and adiposity among children and discuss potential underlying mechanisms.

METHODS

A comprehensive literature search of studies published since the 2010 US National Evidence Library review (January 2010-January 2015) was conducted.

RESULTS

Twelve studies met inclusion criteria. All were conducted in industrialized countries: six in Europe, four in the USA, one in China and one in Australia. Ten of the studies used observational longitudinal designs, with follow-up periods ranging from 1 to 27 years (median: 3, mean: 7.4); of these, eight reported inverse associations between breakfast consumption and excess adiposity, while two found no association. The other studies (1 case-control, 1 experimental) each reported a protective effect of breakfast consumption on overweight and obesity among children.

CONCLUSIONS

Findings corroborate results from previous reviews, adding support for a possible, protective role for breakfast consumption in preventing excess adiposity during childhood and adolescence. However, drawing a causal conclusion from the collective evidence is curtailed by methodological limitations and inconsistencies, including study design, follow-up duration and frequency, exposure and outcome assessment, as well as limited consideration of confounding, mediating and effect-modifying variables. More rigorous study designs employing valid and standardized measurement of relevant variables are needed.

Eating frequency predicts new onset hypertension and the rate of progression of blood pressure, arterial stiffness, and wave reflections

BACKGROUND

Cross-sectional evidence indicates that eating frequency correlates with blood pressure, hypertension, and related target organ damage. The aim of the present study was to prospectively assess eating frequency as a predictor of arteriosclerosis progression and new onset hypertension over a follow-up period of 5 years in adults without cardiovascular disease.

METHODS

Eating frequency among other dietary parameters was evaluated in 115 nondiabetic study participants from a general population sample (54 ± 9.1 years, 45 women) at a baseline visit. Metabolic parameters known to be associated with eating frequency, markers of arteriosclerosis, including augmentation index, pulse wave velocity, SBP, and DBP were evaluated in all volunteers at baseline and after a 5-year follow-up.

RESULTS

By applying linear mixed models analysis, it was found that a high eating frequency at baseline significantly correlated with the rate of progression of pulse wave velocity (β = 0.521, P = 0.004), augmentation index (β = 0.503, P = 0.01), SBP (β = 0.694, P < 0.001), and DBP (β = 0.477, P = 0.009) and the incidence of new onset hypertension (odds ratio = 8.89, P < 0.001). After adjustment traditional cardiovascular risk factors, heart rate, homeostasis model assessment index of insulin resistance and total energy intake, the associations with augmentation index, SBP, DBP, and new onset hypertension remained significant.

CONCLUSION

In a population of nondiabetic adults without cardiovascular disease, eating frequency is associated with the rate of progression of wave reflections, blood pressure and of new onset hypertension. Interventional studies should confirm these data and possibly further assess the utility of eating behavior in the prevention of new onset hypertension and related target organ damage.

Adolescent Snacking Behaviors Are Associated with Dietary Intake and Weight Status

BACKGROUND

Most adolescents consume ≥1 snack/d; exploring the relevance of snacking patterns for overall diet and weight status is important to guide dietary counseling and public health strategies for obesity prevention.

OBJECTIVE

This study examined intake of common energy-dense snack foods, total number of snacks consumed, frequency of consuming snacks prepared away from home, and frequency of snacking while watching television in adolescents and how these behaviors may be linked to diet and weight status. Relations were examined with attention to potential confounders that may help explain the mixed findings of previous research.

METHODS

Survey measures of snacking behavior, a food-frequency questionnaire, and anthropometric measurements were completed by 2793 adolescents (53.2% girls, mean age = 14.4 y) in Minneapolis-St. Paul school classrooms in 2009-2010. Linear regression was used to examine associations with adjustment for sociodemographic characteristics and other potential confounding factors, such as meal skipping, underreporting energy intake, dieting to lose weight, and physical activity.

RESULTS

Adolescents reported consuming a mean of 2.2 energy-dense snack food servings/d and 4.3 snacks/d and purchasing snacks prepared away from home on 3.2 occasions/wk. More than two-thirds of adolescents reported that they sometimes, usually, or always consumed a snack while watching television. The measures of snacking were directly associated (P < 0.01) with higher energy, lower fruit/vegetable, higher sugar-sweetened beverage, and more frequent fast-food intakes in all models except for one: energy-dense snack food servings were not related to sugar-sweetened beverage intake. A direct relation between daily servings of energy-dense snack foods and body mass index (BMI) z score was found; however, the snacking behaviors were inversely related to BMI z score (P < 0.01).

CONCLUSIONS

The observed cross-sectional associations suggest that snack consumption is a risk factor for poor diet, but unless energy-dense foods are consumed, snacking does not consistently contribute to overweight in US adolescents.

Meal size is a critical driver of weight gain in early childhood

Larger serving sizes and more frequent eating episodes have been implicated in the rising prevalence of obesity at a population level. This study examines the relative contributions of meal size and frequency to weight gain in a large sample of British children. Using 3-day diet diaries from 1939 children aged 21 months from the Gemini twin cohort, we assessed prospective associations between meal size, meal frequency and weight gain from two to five years. Separate longitudinal analyses demonstrated that every 10 kcal increase in meal size was associated with 1.5 g/wk or 4% (p = 0.005) faster growth rate, while meal frequency was not independently associated with growth (β = 0.3 g/wk p = 0.20). Including both meal parameters in the model strengthened associations (meal size: β = 2.6 g/wk, p < 0.001; meal frequency: β = 1.0 g/wk, p = 0.001). Taken together, the implication is that meal size promotes faster growth regardless of frequency, but meal frequency has a significant effect only if meal size is assumed to be held constant. Clearer advice on meal size and frequency, especially advice on appropriate meal size, may help prevent excess weight gain.

Snacking Is Longitudinally Associated with Declines in Body Mass Index z Scores for Overweight Children, but Increases for Underweight Children

BACKGROUND

Few studies, to our knowledge, have examined the longitudinal association of snacking with child body mass index (BMI), especially in China, where the incidence of overweight and obesity has increased rapidly.

OBJECTIVES

Our objective was to examine the longitudinal association between snacking and BMI z score and to test whether this association differs by baseline weight status.

METHODS

Using data from the China Health and Nutrition Survey (2006, 2009, and 2011), we characterized snack intake for 9 provinces and 3 megacities. We used linear mixed-effects models to examine longitudinally the association between snacking (none, low, medium, and high tertiles according to energy) and BMI z score in children aged 2-13 y at baseline, controlling for sex, urbanicity, parental education, physical activity, and foods consumed at meals (n = 2277 observations). We tested whether this association differed by baseline underweight, normal weight, or overweight/obese.

RESULTS

Snacking is prevalent in Chinese children, with fruit being the most common snack. Snacking was not associated with meaningful BMI z score changes in normal-weight children. However, in children who were underweight at baseline, snacking in the top tertiles was associated with increases in BMI z scores from 2006 to 2011 (+1.2 and +1.1 BMI z score units for ages 2-6 and 7-13 y, respectively) (P < 0.05). In overweight/obese 2- to 6-y-old children at baseline, being in the lowest snacking tertile was associated with declines in BMI z score (-3.3), whereas in overweight 7- to 13-y-old children, being in the top tertile of snacking was associated with the greatest decline in BMI z score (-2.1) (P < 0.05). The direction and magnitude of associations did not vary regardless of adjustment for total energy intake.

CONCLUSIONS

Snacking in China, dominated by fruit consumption, is associated with decreased BMI in overweight/obese children and increased BMI in underweight children. More work will be needed to monitor this relation as Chinese diets continue to westernize.

What Is a Snack, Why Do We Snack, and How Can We Choose Better Snacks? A Review of the Definitions of Snacking, Motivations to Snack, Contributions to Dietary Intake, and Recommendations for Improvement

Around the world, adults consume energy outside of traditional meals such as breakfast, lunch, and dinner. However, because there is no consistent definition of a "snack," it is unclear whether those extra eating occasions represent additional meals or snacks. The manner in which an eating occasion is labeled (e.g., as a meal or a snack) may influence other food choices an individual makes on the same day and satiety after consumption. Therefore, a clear distinction between "meals" and "snacks" is important. This review aims to assess the definition of extra eating occasions, to understand why eating is initiated at these occasions, and to determine what food choices are common at these eating occasions in order to identify areas for dietary intervention and improvement. Part I of this review discusses how snacking is defined and the social, environmental, and individual influences on the desire to snack and choice of snack. The section concludes with a brief discussion of the associations of snacking with cardiometabolic health markers, especially lipid profiles and weight. Part II addresses popular snack choices, overall snacking frequencies, and the demographic characteristics of frequent snackers in several different countries. This review concludes with a recommendation for nutrition policymakers to encourage specific health-promoting snacks that address nutrient insufficiencies and excesses.

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

The association between eating frequency (EF) and adiposity in young populations is inconsistent. This cross-sectional study examined associations of EF, meal frequency (MF) and snack frequency (SF) with adiposity measures in US children aged 6–11 years (n 4346) and adolescents aged 12–19 years (n 6338) participating in the National Health and Nutrition Examination Survey 2003–2012. Using data from two 24-h dietary recalls, all eating occasions providing ≥210 kJ of energy were divided into meals or snacks based on contribution to energy intake (≥15 or <15 %), self-report and time (06.00–09.00, 12.00–14.00 and 17.00–20.00 hours or others). When analysed without adjustment for the ratio of reported energy intake:estimated energy requirement (EI:EER), all measures of EF, MF and SF showed inverse or null associations with overweight (BMI≥85th percentile of BMI-for-age) and abdominal obesity (waist circumference≥90th percentile) in both children and adolescents. After adjustment for EI:EER, however, EF and SF, but not MF, showed positive associations in children, irrespective of the definition of meals and snacks. In adolescents, after adjustment for EI:EER, positive associations were observed for EF (abdominal obesity only), SF based on energy contribution and MF based on self-report, whereas there was an inverse association between MF based on energy contribution and overweight. In conclusion, higher SF and EF, but not MF, were associated with higher risks of overweight and abdominal obesity in children, whereas associations varied in adolescents, depending on the definition of meals and snacks. Prospective studies are needed to establish the associations observed here.

Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN-IV Study

OBJECTIVES

This study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents.

METHODS

This nationwide cross-sectional study was performed on a multi-stage sample of 14,880 students, aged 6-18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors.

RESULTS

Eating more frequently (≥ 6 vs. ≤ 3) was found among students who were at younger age (11.91 vs. 13.29 years) (p<0.001). Students who reported an EF of 4 (OR: 0.67, CI: 0.57-0.79), 5 (OR: 0.74, CI: 0.62-0.87), and 6 (OR: 0.54, CI: 0.44-0.65) had lower odds of being obese compared to those who had EF ≤ 3. Having EF of 4 (OR: 0.82, CI: 0.71-0.94), 5 (OR: 0.86, CI: 0.74-0.99), and ≥ 6 (OR: 0.73, CI: 0.63-0.85) was related to lower prevalence of abdominal adiposity.

CONCLUSION

Higher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long-term effects of EF on body composition in the pediatric age group.