Snacking is associated with reduced risk of overweight and reduced abdominal obesity in adolescents: National Health and Nutrition Examination Survey (NHANES) 1999-2004

The effects of meal patterns on liver steatosis, fibrosis, and biochemical factors in patients with nonalcoholic fatty liver disease: a randomized controlled clinical trial

Background

This study was designed to compare the effects of four meal patterns on liver steatosis, fibrosis, and biochemical factors in patients with Nonalcoholic fatty liver disease (NAFLD).

Methods

The 12-week intervention was performed on 123 patients with NAFLD who were randomly allocated into four groups: "3-meals", "skipping breakfast", "skipping dinner", and " 3 meals and 3 snacks per day." group. The assessment of liver steatosis, fibrosis, biochemical factors, and anthropometrical evaluation were performed at baseline and at end of the study.

Results

A significant improvement was found in the liver steatosis and fibrosis among the patients who consumed 3 meals, 3 snacks compared to the other groups (P < 0.001). In addition, a higher reduction was observed in serum levels of alanine amino transferase (ALT) (20.93 ± 23.37 mg/dl, P < 0.001), aspartate aminotransferase (AST) (17.15 ± 16.48 mg/dl, P < 0.001), gamma-glutamyl transferase(GGT) (13.43 ± 13.41 mg/dl; P < 0.001), and alkaline phosphatase (ALK) (47.19 ± 60.51 mg/dl; P = 0.004) in patients who consumed 3 meals, 3 snacks, while the concentration of liver enzymes in patients who consumed 3 meals increased significantly. At the end of the study, there was a significant increase in the fasting blood sugar (FBS) concentration in the "skipping breakfast" group (17.51 ± 38.85 mg/dl; P = 0.011) and "3-meals" group (17.51 ± 38.85 mg/dl, P = 0.03).

Conclusion

Consuming 3 meals, 3 snack per day significantly improves disease severity and biochemical factors in NAFLD patients. Further studies are warranted.

Trial registration number

: IRCT20201010048982N2. Name of the registry: Urmia University of Medical Sciences. Date of registration: 2021-08-22, 1400/05/31. URL of trial registry record: https://www.irct.ir/search/result?query=IRCT20201010048982N2.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01375-2.

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

CONTEXT

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

OBJECTIVE

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

DATA EXTRACTION

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

DATA ANALYSIS

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

CONCLUSION

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Changes in Food Consumption and Eating Behaviours of Children and Their Families Living in Italy during the COVID-19 Pandemic: The EPaS-ISS Study

The aim of the EPaS-ISS study was to describe the changes in food consumption and eating behaviours of children (mainly aged 8-9 years) and their families between the pre-COVID-19 period (before February/March 2020) and the COVID-19 period (from February/March 2020 to April 2022). A web questionnaire completed by parents was used to collect data. The sociodemographic characteristics of the children and their parents were also explored through the web questionnaire. Seventeen regions out of nineteen and the two autonomous provinces (PA) of Italy participated in the study. The survey was completed for 4863 children (47.9% females). The study showed that only small changes in children's food consumption happened between the pre-COVID-19 period and the COVID-19 period; in particular, about 25% of parents reported an increase in savoury snacks and sweet food. A decrease in fruit and vegetable (about 8%) and fish (14%) consumption was also found. However, the changes seem to have mainly affected children from most disadvantaged families. The results also indicate positive changes during the COVID-19 pandemic in some families' eating behaviours, such as eating more home-cooked meals (42%) and family meals (39%), as well as cooking more with children (42%).

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

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

Self-Reported Eating-Occasion Frequency and Timing are Reproducible and Relatively Valid in the American Cancer Society Cancer Prevention Study-3 Diet Assessment Substudy

BACKGROUND

Accurate assessment of eating-occasion behaviors, such as timing, frequency, and consumption intervals, is important for evaluating associations with obesity and other chronic diseases.

OBJECTIVES

The main objective of this study was to assess the relative validity of a 24-hour grid approach to assess eating-occasion timing and frequency in comparison to data derived from repeated 24-hour dietary recalls (DRs). A second objective was to assess the 1-year test-retest reproducibility of the 24-hour grid.

METHODS

Between 2015 and 2016, 626 participants in the Cancer Prevention Study-3 (CPS-3) Diet Assessment Substudy (mean age, 52 years; age range, 31-70 years; 64% female; 64% non-Hispanic white, 22% non-Hispanic black, 14% Hispanic) completed 2 grids and up to 6 unannounced, telephone, interviewer-administered DRs over 1 year. Spearman correlations (ρ; 95% CIs) were calculated to assess reproducibility between the repeated eating-occasion grid-derived variables (e.g., numbers of snacks and meals per day, timing of eating occasions) and to assess relative validity by comparing the meal grid and DR-derived summary data separately for weekdays and weekend days.

RESULTS

Reproducibility correlations for eating-occasion variables derived from the eating-occasion grids completed 1 year apart were ≥0.5 for the majority of variables analyzed for both weekdays and weekend days, including numbers of snacks and meals per day and timing of the first and last eating occasions of the day. Relative validity was highest among weekday variables and was ≥0.5 for the majority of variables, with correlations ranging from ρ values of 0.32 (number of meals per day) to 0.68 (hour of the first eating occasion).

CONCLUSIONS

These findings suggest the eating-occasion grid used in CPS-3 has good reproducibility over 1 year and yields estimates comparable to those from a more detailed method of assessment of eating timing and frequency.

Certain dietary patterns including potatoes are associated with higher and lower diet quality and physiological measures in children and adults, NHANES 2001-2018

A large percentage of daily vegetable intake is attributed to white potatoes, but limited information is available on how potatoes are incorporated into dietary patterns in the US. Therefore, the objective of this study was to determine food patterns that include potatoes and to compare the associated diet quality and association with biomarkers to a food pattern without potatoes. Data from American subjects 2-18 and 19 years and older who participated in the What We Eat in America portion of the National Health and Nutrition Examination Survey cycles 2001-2018 were utilized in the current study. Diet quality was assessed using the Healthy Eating Index-2015. Anthropometric variables included body mass index (BMI), waist circumference, and weight. Biomarkers analyzed included glucose, insulin, triglycerides, HDL-, LDL-, and total cholesterol. Multiple food clusters containing potatoes were identified with several having higher and lower diet quality as compared to a food pattern without potatoes. Children and adolescents in one potato cluster had lower BMI, waist circumference, and body weight compared to those in a no potato dietary pattern, whereas adults in 3 potato clusters had higher anthropometric variables than those in a no potato pattern. In adults, some dietary patterns including potatoes were also associated with lower and higher HDL and total cholesterol and higher insulin levels. The percentage of calories from potatoes across patterns was small, ∼9-12%, suggesting the differences observed in diet quality and biomarkers were due to other food categories consumed in the pattern. This study suggests there are ways to incorporate potatoes as part of a healthy eating pattern but depends more on the other foods included in the diet.

The effects of grazing on daily caloric intake and dietary quality

Background

The duration and frequency of eating occasions has been identified as a factor contributing to poor dietary quality among U.S. adults. The objective of this study is to examine whether grazing, defined as eating more than three times a day, affects total daily caloric intake and dietary quality measured by the 2015 Healthy Eating Index (HEI-2015).

Methods

We used a multivariate individual fixed-effects model to compare the caloric intake and dietary quality of individuals who grazed on 1 day but not another. This allowed us to control for differences in individual food intake and diet quality preferences among study participants. We use the National Health and Nutrition Examination Survey (NHANES), 2007-2018, and include data for adults aged 18 years or older who reported 2 days of dietary intake and were not pregnant or lactating (n = 27,775).

Results

Grazing increased total daily caloric intake by 205 cal and increased the daily HEI score by 0.59 points. Grazing increased HEI component scores for total fruit, whole fruit, and refined grains, and decreased HEI component scores for saturated fats. Morning grazing increased total daily caloric intake by 159 cal and increased the daily HEI score by 0.87 points — primarily by increasing component scores for total fruit, whole fruit, whole grains, total dairy, seafood and plant proteins, and sodium. Evening grazing increased daily caloric intake by 76 cal and decreased the daily HEI score by 0.41 points — primarily by decreasing the component scores for total fruit, whole grains, fatty acids, and saturated fats. Evening grazing increased HEI component scores for sodium and refined grains.

Conclusions

Grazing increases daily caloric intake and can decrease dietary quality (particularly when grazing in the evening).

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

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

Effects of 6 Months of Soy-Enriched High Protein Compared to Eucaloric Low Protein Snack Replacement on Appetite, Dietary Intake, and Body Composition in Normal-Weight Obese Women: A Randomized Controlled Trial

(1) Background: The favorable effects of high protein snacks on body composition and appetite status in lean and athletic populations have been illustrated previously. However, the effects of soy-enriched high protein snacks have not been investigated in women with normal-weight obesity (NWO). Consequently, we aimed at comparing the effects of six months of soy-enriched high protein snack replacement on appetite, body composition, and dietary intake in women with NWO. (2) Methods: One hundred seven (107) women with NWO [(age: 24 ± 3 yrs, BMI: 22.7 ± 2.3 kg/m², body fat percentage (BFP): 38 ± 3.2%)] who were assigned to one of two groups; high protein snack (HP, n = 52) containing 50 g soybean or isocaloric low-protein snack (protein: 18.2 g, carbohydrate: 15 g, fat: 10 g, energy: 210 kcal) or isocaloric low protein snack (LP, n = 55) containing 3.5 servings of fruit (protein: <2 g, carbohydrate: ≈50 g, fat: <1 g, energy: ≈210 kcal) as part of their daily meals (as a snack at 10 a.m.), successfully completed the study interventions. Body mass (BM), body mass index (BMI), waist circumference (WC), BFP, skeletal muscle mass, dietary intake, and appetite levels were evaluated prior to and after the six-month intervention. (3) Results: Appetite (HP = -12 mm and LP = -0.6 mm), energy intake (HP = -166.2 kcal/day and LP = 91.3 kcal), carbohydrate intake (HP = -58.4 g/day and LP = 6.4 g/day), WC (HP = -4.3 cm and LP = -0.9 cm), and BFP (HP = -3.7% and LP = -0.9%) were significantly (p < 0.05) reduced, while skeletal muscle mass (HP = 1.2 kg and LP = 0.3 kg) significantly increased in the HP compared to the LP group, respectively. (4) Conclusions: Six months of a soy-enriched high protein snack replacement decreased appetite and improved body composition in women with NWO. Our findings suggest that soy-enriched high protein snacks are an efficacious strategy for body composition improvement.

Snacking patterns throughout the life span: potential implications on health

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

Ingested but not perceived: Response to satiety cues disrupted by perceptual load

Selective attention research has shown that when perceptual demand is high, unattended sensory information is filtered out at early stages of processing. We investigated for the first time whether the sensory and nutrient cues associated with becoming full (satiety) would be filtered out in a similar manner. One-hundred and twenty participants consumed either a low-satiety (75 kcal) or high-satiety (272 kcal plus thicker texture) beverage, delivered via an intra-oral infusion device while participants simultaneously completed a task which was either low or high in perceptual demand. Among participants who performed the low perceptual load task, ingestion of the high-satiety beverage increased rated satiety and reduced consumption at a subsequent snack test. However, both effects were eliminated by the high perceptual load task. Therefore, the processing of satiety cues was dependent on the availability of attention, identifying a novel perceptual load mechanism of inattentive eating and supporting more recent cognitive models of appetite control.

The genetic architecture of the association between eating behaviors and obesity: combining genetic twin modeling and polygenic risk scores

BACKGROUND

Obesity susceptibility genes are highly expressed in the brain suggesting that they might exert their influence on body weight through eating-related behaviors.

OBJECTIVES

To examine whether the genetic susceptibility to obesity is mediated by eating behavior patterns.

METHODS

Participants were 3977 twins (33% monozygotic, 56% females), aged 31-37 y, from wave 5 of the FinnTwin16 study. They self-reported their height and weight, eating behaviors (15 items), diet quality, and self-measured their waist circumference (WC). For 1055 twins with genome-wide data, we constructed a polygenic risk score for BMI (PRSBMI) using almost 1 million single nucleotide polymorphisms. We used principal component analyses to identify eating behavior patterns, twin modeling to decompose correlations into genetic and environmental components, and structural equation modeling to test mediation models between the PRSBMI, eating behavior patterns, and obesity measures.

RESULTS

We identified 4 moderately heritable (h2 = 36-48%) eating behavior patterns labeled "snacking," "infrequent and unhealthy eating," "avoidant eating," and "emotional and external eating." The highest phenotypic correlation with obesity measures was found for the snacking behavior pattern (r = 0.35 for BMI and r = 0.32 for WC; P < 0.001 for both), largely due to genetic factors in common (bivariate h2 > 70%). The snacking behavior pattern partially mediated the association between the PRSBMI and obesity measures (βindirect = 0.06; 95% CI: 0.02, 0.09; P = 0.002 for BMI; and βindirect = 0.05; 95% CI: 0.02, 0.08; P = 0.003 for WC).

CONCLUSIONS

Eating behavior patterns share a common genetic liability with obesity measures and are moderately heritable. Genetic susceptibility to obesity can be partly mediated by an eating pattern characterized by frequent snacking. Obesity prevention efforts might therefore benefit from focusing on eating behavior change, particularly in genetically susceptible individuals.

Eating Habits of Children Born after Maternal Bariatric Surgery

Mothers who underwent bariatric surgery (BS) before pregnancy have worrisome eating habits, but little is known about the eating habits of their offspring. EFFECTOR is a cross-sectional, long-term follow-up study of 4-11-year-old children born from mothers that underwent bariatric surgery before pregnancy (n = 36), mothers with overweight/obesity (OW/OB) in a control group (n = 71), and mothers with a normal weight (NW) in a second control group (n = 35). Data on anthropometry and on eating habits obtained through a Food Frequency Questionnaire were collected prospectively. The children's body mass index (BMI) scores significantly correlated with maternal pre-pregnancy BMI. The prevalence of overweight and obesity was the highest in children of the BS group (38.9% vs. 15.5% for children of the OW/OB group and 5.7% for those of the NW group; p = 0.004). Meal-skipping behavior was comparable between the groups. There was no difference in fruit and vegetable consumption. The BS group consumed more low-calorie sweetened beverages compared to the NW group (p = 0.01) but less fruit juice compared to the NW and OW/OB groups (p = 0.01). Our results may indicate a sugar-avoiding behavior in children of the BS group, fitting dietary maternal habits in a strategy to prevent dumping syndrome. In conclusion, maternal pre-pregnancy bariatric surgery does not alter unhealthy eating behaviors and the risk of development of overweight during childhood in their children.

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.

The effect of environmental factors in childcare facilities and individual lifestyle on obesity among Japanese preschool children; a multivariate multilevel analysis

Lifestyle in preschool children is associated with the onset of childhood obesity. However, the effect of environmental factors in childcare facilities on lifestyle and obesity in preschool children is unknown. The aim of this study was to determine the effect of environmental factors in childcare facilities on the association between obesity and individual lifestyle in preschool children.Subjects included 2902 infants, aged 4 to 6 years old in Kitakyushu City, Japan. A stratified multilevel analysis was conducted with 2 strata: factors related to individual lifestyle and maternal factors as the individual level and factors related to the childcare facility as the environmental level. Two-level multilevel regression analysis was conducted with the presence or absence of obesity.The proportion of infants with obesity was 4.2%. The childhood obesity was significantly associated with the mastication, nutritional methods during infancy, absence of breakfast, presence of skipping meals due to overeating of snacks, usual play activity, screen time on weekdays, maternal body mass index, and maternal weight increase during pregnancy at the individual level. On the other hand, childhood obesity had a significantly negative association with the receiving snacks in facilities by using multilevel analysis.The present study revealed that establishing and maintaining environmental factors in childcare facilities may play important roles in the prevention of obesity from early childhood.

Dietary Behaviour Is Associated with Cardiometabolic and Psychological Risk Indicators in Female Hospital Nurses-A Post-Hoc, Cross-Sectional Study

Unfavourable dietary behaviours of female nurses, especially among shift-working nurses, including high snacking frequency, short fasting period and large day-to-day energy intake variability may be linked with adverse health. In this study we: (1) examined the relationship between dietary behaviour and cardiometabolic and psychological health in female nurses; and, (2) compared dietary behaviour, cardiometabolic and psychological health between shift-working and non-shift-working female nurses. A total of 73 nurses had their cardiometabolic health indicators evaluated and completed psychological health questionnaires; 55 completed a 3-day dietary log. Associations between dietary behaviour and health measures were examined using Spearman's partial correlation analysis. Analysis of covariance (ANCOVA) was used to compare dietary behaviour and health indicators between shift- and non-shift-working nurses. The majority of snacks consumed by nurses (70%) were unhealthy snacks (e.g., chocolate and chips), and higher snacking frequency was associated with greater percent body fat (r(50) = 0.287, p = 0.039), and worse mood-tension (r(48) = 0.327, p = 0.021) and anger-hostility (r(48) = 0.289, p = 0.042) scores. Day-to-day energy intake variability was positively associated with body mass index (BMI, r(50) = 0.356, p = 0.010) and waist circumference (r(50) = 0.283, p = 0.042). Shift-working nurses exhibited shorter fasting duration, larger day-to-day energy intake variability and higher total mood disturbance score when compared to their non-shift-working colleagues (all p < 0.05). The results of the present study suggested that addressing dietary behaviours may improve the cardiometabolic and psychological health of female nurses. Shift-working nurses may require a more specific dietary program to improve their psychological health.

Associations between Food Consumption Patterns and Chronic Diseases and Self-Reported Morbidities in 6 American Indian Communities

Background

American Indian (AI) have the highest rates of diet-related chronic diseases in the country. Yet, the relation between dietary patterns and chronic diseases in this population has not been well explored.

Objective

We aimed to characterize common dietary patterns among adults from 6 AI communities (N = 580) and assess their relation with BMI, percentage body fat, waist-to-hip ratio, hypertension, and self-reported type 2 diabetes and cardiovascular disease.

Methods

We conducted a baseline assessment of an obesity prevention study (N = 580). Dietary intake data were collected using a modified Block FFQ. Exploratory factor analysis was used to characterize dietary patterns. We used multivariate linear and logistic regression analyses to assess associations between dietary patterns and health outcomes, controlling for age, sex, employment status, smoking status, geographic region, and energy intake.

Results

Five dietary patterns, explaining 81.8% of variance in reported food consumption, were identified: “meat and fried foods,” “processed foods,” “fruits and vegetables,” “sugary snacks,” and “meat alternatives and high-protein foods.” “Those with higher consumption of “meat and fried foods” were associated with higher mean waist-to-hip ratio (0.03; 95% CI: 0.01, 0.04), higher mean BMI (2.45 kg/m2; 95% CI: 0.83, 4.07), and increased odds of being overweight or obese (OR: 2.63; 95% CI: 1.10, 6.31) compared to those with lower consumption of “meat and fried foods.” Higher consumption of “processed foods” was associated with increased odds of self-reported type 2 diabetes (OR: 3.41; 95% CI: 1.31, 8.90). No protective effect of consumption of “fruits and vegetables” was observed, although average consumption was below national recommendation levels.

Conclusions

AI dietary patterns corroborate nutritional concerns previously reported among AI populations. Future interventions should discourage overconsumption of meat, fried foods, and processed foods, and promote consumption of fruits and vegetables to reduce chronic disease burden in this population.

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.

Associations between Snacking and Weight Status among Adolescents 12-19 Years in the United States

Snacking is a significant contributor to energy intake among adolescents, but its association with weight status is unclear. To elucidate this association, data from 6545 adolescents (12-19 years) in the 2005-2016 National Health and Nutrition Examination Survey (NHANES) were analyzed. The mean number of daily snack occasions, mean snack size, and mean snack energy density were examined by weight classification (body mass index (BMI)-for-age percentiles: normal weight (NW) <85th; overweight (OW) ≥85th to <95th; obese (OB) ≥95th). Models included all snacking parameters, mean meal size, demographic characteristics, survey cycle year, and dietary reporting accuracy. Adolescents with NW consumed fewer snacks daily (1.69 (0.02) snacks/day) and smaller snacks per occasion (262.32 (4.41) calories (kcal)/snack) compared to adolescents with OW (1.85 (0.05) snacks/day, p = 0.005; 305.41 (8.84) kcal/snack, p < 0.001), and OB (1.97 (0.05) snacks/day; 339.60 (10.12) kcal/snack, both p < 0.001). Adolescents with OW and OB also consumed more added sugar, saturated fat and sodium from snacks, but had lower mean energy density per snack compared to snacks consumed by NW adolescents. US adolescents with OW and OB consume more snacks daily and more calories at each snacking occasion compared to adolescents with NW. Future studies should examine the prospective associations between snacking and weight status and impact on overall diet quality.

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

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

Snack Consumption Patterns among Canadians

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

Stressing the importance of choice: Validity of a preclinical free-choice high-caloric diet paradigm to model behavioural, physiological and molecular adaptations during human diet-induced obesity and metabolic dysfunction

Humans have engineered a dietary environment that has driven the global prevalence of obesity and several other chronic metabolic diseases to pandemic levels. To prevent or treat obesity and associated comorbidities, it is crucial that we understand how our dietary environment, especially in combination with a sedentary lifestyle and/or daily-life stress, can dysregulate energy balance and promote the development of an obese state. Substantial mechanistic insight into the maladaptive adaptations underlying caloric overconsumption and excessive weight gain has been gained by analysing brains from rodents that were eating prefabricated nutritionally-complete pellets of high-fat diet (HFD). Although long-term consumption of HFDs induces chronic metabolic diseases, including obesity, they do not model several important characteristics of the modern-day human diet. For example, prefabricated HFDs ignore the (effects of) caloric consumption from a fluid source, do not appear to model the complex interplay in humans between stress and preference for palatable foods, and, importantly, lack any aspect of choice. Therefore, our laboratory uses an obesogenic free-choice high-fat high-sucrose (fc-HFHS) diet paradigm that provides rodents with the opportunity to choose from several diet components, varying in palatability, fluidity, texture, form and nutritive content. Here, we review recent advances in our understanding how the fc-HFHS diet disrupts peripheral metabolic processes and produces adaptations in brain circuitries that govern homeostatic and hedonic components of energy balance. Current insight suggests that the fc-HFHS diet has good construct and face validity to model human diet-induced chronic metabolic diseases, including obesity, because it combines the effects of food palatability and energy density with the stimulating effects of variety and choice. We also highlight how behavioural, physiological and molecular adaptations might differ from those induced by prefabricated HFDs that lack an element of choice. Finally, the advantages and disadvantages of using the fc-HFHS diet for preclinical studies are discussed.

The Influence of Meal Frequency and Timing on Health in Humans: The Role of Fasting

The influence of meal frequency and timing on health and disease has been a topic of interest for many years. While epidemiological evidence indicates an association between higher meal frequencies and lower disease risk, experimental trials have shown conflicting results. Furthermore, recent prospective research has demonstrated a significant increase in disease risk with a high meal frequency (≥6 meals/day) as compared to a low meal frequency (1⁻2 meals/day). Apart from meal frequency and timing we also have to consider breakfast consumption and the distribution of daily energy intake, caloric restriction, and night-time eating. A central role in this complex scenario is played by the fasting period length between two meals. The physiological underpinning of these interconnected variables may be through internal circadian clocks, and food consumption that is asynchronous with natural circadian rhythms may exert adverse health effects and increase disease risk. Additionally, alterations in meal frequency and meal timing have the potential to influence energy and macronutrient intake.A regular meal pattern including breakfast consumption, consuming a higher proportion of energy early in the day, reduced meal frequency (i.e., 2⁻3 meals/day), and regular fasting periods may provide physiological benefits such as reduced inflammation, improved circadian rhythmicity, increased autophagy and stress resistance, and modulation of the gut microbiota.

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.

Association of Dietary Habits and Interest for Food and Science versus Weight Status in Children Aged 8 to 18 Years

INTRODUCTION

This study aims to describe the association between dietary habits and weight status and the interest in food and science.

METHODS

We examined in a cross-sectional study 525 children aged between 8 and 18 years, who attended the Brussels Food Fair or the Belgian Science Day in 2013. They were divided into three groups: special interest in science, special interest in food, and a general control group. They completed a questionnaire, and body parameters were measured. The weight status of the children was identified using the growth charts and the calculated BMI.

RESULTS

In total, 525 children were included: 290 children in the reference group, 194 in the food group, and 41 in the science group. The prevalence of overweight and obesity was 28% in the general control group, 14% in the food group, and 15% in the science group. Breakfast and dinner were skipped more often by children with overweight or obesity. Children from the food and science groups had more sweets and meat, had less fruit, and skipped less meals.

CONCLUSION

In our study, 28% of the reference group had overweight or obesity. The children with special interest in food or science differed from the control group.

Meal Frequency and Timing Are Associated with Changes in Body Mass Index in Adventist Health Study 2

Background: Scientific evidence for the optimal number, timing, and size of meals is lacking.Objective: We investigated the relation between meal frequency and timing and changes in body mass index (BMI) in the Adventist Health Study 2 (AHS-2), a relatively healthy North American cohort.Methods: The analysis used data from 50,660 adult members aged ≥30 y of Seventh-day Adventist churches in the United States and Canada (mean ± SD follow-up: 7.42 ± 1.23 y). The number of meals per day, length of overnight fast, consumption of breakfast, and timing of the largest meal were exposure variables. The primary outcome was change in BMI per year. Linear regression analyses (stratified on baseline BMI) were adjusted for important demographic and lifestyle factors.Results: Subjects who ate 1 or 2 meals/d had a reduction in BMI per year (in kg · m^-2 · y^-1) (-0.035; 95% CI: -0.065, -0.004 and -0.029; 95% CI: -0.041, -0.017, respectively) compared with those who ate 3 meals/d. On the other hand, eating >3 meals/d (snacking) was associated with a relative increase in BMI (P < 0.001). Correspondingly, the BMI of subjects who had a long overnight fast (≥18 h) decreased compared with those who had a medium overnight fast (12-17 h) (P < 0.001). Breakfast eaters (-0.029; 95% CI: -0.047, -0.012; P < 0.001) experienced a decreased BMI compared with breakfast skippers. Relative to subjects who ate their largest meal at dinner, those who consumed breakfast as the largest meal experienced a significant decrease in BMI (-0.038; 95% CI: -0.048, -0.028), and those who consumed a big lunch experienced a smaller but still significant decrease in BMI than did those who ate their largest meal at dinner.Conclusions: Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain. Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.

Dietary fibre in Europe: current state of knowledge on definitions, sources, recommendations, intakes and relationships to health

Research into the analysis, physical properties and health effects of dietary fibre has continued steadily over the last 40–50 years. From the knowledge gained, countries have developed guidelines for their populations on the optimal amount of fibre to be consumed each day. Food composition tables from many countries now contain values for the dietary fibre content of foods, and, from these, combined with dietary surveys, population intakes have been determined. The present review assessed the uniformity of the analytical methods used, health claims permitted, recommendations and intakes, particularly from national surveys across Europe and around the world. It also assessed current knowledge on health effects of dietary fibre and related the impact of different fibre types on health. The overall intent was to be able to provide more detailed guidance on the types of fibre which should be consumed for good health, rather than simply a total intake figure, the current situation. Analysis of data indicated a fair degree of uniformity in the definition of dietary fibre, the method used for analysis, the recommended amount to be consumed and a growing literature on effects on digestive health and disease risk. However, national dietary survey data showed that intakes do not reach recommendations and very few countries provide guidance on the types of fibre that are preferable to achieve recommended intakes. Research gaps were identified and ideas suggested to provide information for more detailed advice to the public about specific food sources that should be consumed to achieve health benefits.

Is snack consumption associated with meal skipping in children and adolescents? The CASPIAN-IV study

PURPOSE

The present inquiry set to assess the relationship between snack consumption and meal skipping in Iranian children and adolescents.

METHODS

Overall, 14,880 students, aged 6-18 years, were selected via multistage cluster sampling method from rural and urban areas of 30 provinces of Iran. A validated questionnaire of food behaviors including questions on snacks consumption and taking/skipping meals was completed. Consuming and skipping meals and their related factors were reported in both crude and adjusted models.

RESULTS

Overall, 13,486 students with a mean age of 12.47 ± 3.36 years completed the study (90.6% participation rate). Among them, 32.08, 8.89, and 10.90% skipped breakfast, lunch, and dinner, respectively. Compared to their counterpart groups, the frequency of meal skipping was higher in girls, urban inhabitants, and students in higher school grades (P < 0.05). Snack consumption was associated with an increased odds ratio of meal skipping in many types of snack groups.

CONCLUSIONS

Meal skipping and snack consumption were frequent among Iranian children and adolescents. Evidence based interventions are proposed to improve the students' eating habits.

The addition of peanuts to habitual diets is associated with lower consumption of savory non-core snacks by men and sweet non-core snacks by women

Snacking is associated with intakes of non-core foods which may predispose to obesity. Peanuts have potential satiety benefits and may assist with weight management; we hypothesized that peanut consumption would reduce intake of non-core snack foods due to compensation. We investigated the effects of adding peanuts to a habitual diet on snacking habits and energy intake. Sixty-one healthy participants (65±7years, body mass index 31±4kg/m²) consumed their habitual diet with or without peanuts (56g/d for 32 women, 84g/d for 29 men) for 12weeks each in a randomized crossover design. Food diaries were analyzed at baseline and after each 12-week period for meal and snack content and timing. Total energy intake was higher (17% for men [P<.001], 9% for women [P<.001]) during the peanut phase. Body weight was 0.5±0.2kg (P=.010) greater during the peanut phase. Snacking occasions increased during the peanut phase (53% for men [P=.001], 14% for women [P=.01]). Servings of other snack foods did not change during the peanut phase (P=.6) compared with control. However, sex-specific analysis revealed that men and women consumed less savory (P<.001) and sweet (P=.01) non-core snacks, respectively, during the peanut phase. Despite increased energy intake and snacking frequency, peanuts may improve the diet through sex-specific reductions of non-core foods; for optimal energy balance, peanuts should be substituted rather than added to the diet.

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.

Homeostatic responses to palatable food consumption in satiated rats

OBJECTIVE

Energy intake is regulated by overlapping homeostatic and hedonic systems. Consumption of palatable foods has been implicated in weight gain, but this assumes that homeostatic control systems do not accurately detect this hedonically driven energy intake. This study tested this assumption, hypothesizing that satiated rats would reduce their voluntary food intake and maintain a stable body weight after consuming a palatable food.

METHODS

Lean rats or rats previously exposed to an obesogenic diet were schedule-fed with fixed or varying amounts of palatable sweetened condensed milk (SCM) daily, and their voluntary energy intake and body weight were monitored.

RESULTS

During scheduled feeding of SCM, rats voluntarily reduced bland food consumption and maintained a stable body weight. This behavior was also seen in rats with access to an obesogenic diet and was independent of the predictability of SCM access. However, lean rats offered large amounts of SCM showed an increase in total energy intake. To test whether a nutrient deficiency drove this under-compensatory behavior, SCM was enriched with protein. However, no effect was seen on voluntary energy intake.

CONCLUSIONS

In schedule-fed rats, compensatory reductions in voluntary energy intake were seen, but under-compensation was observed if large amounts of SCM were consumed.

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.

Gender Difference on the Association between Dietary Patterns and Obesity in Chinese Middle-Aged and Elderly Populations

Dietary patterns are linked to obesity, but the gender difference in the association between dietary patterns and obesity remains unclear. We explored this gender difference in a middle-aged and elderly populations in Shanghai. Residents (n = 2046; aged ≥45 years; 968 men and 1078 women) who participated in the Shanghai Food Consumption Survey were studied. Factor analysis of data from four periods of 24-h dietary recalls (across 2012-2014) identified dietary patterns. Height, body weight, and waist circumference were measured to calculate the body mass index. A log binominal model examined the association between dietary patterns and obesity, stratified by gender. Four dietary patterns were identified for both genders: rice staple, wheat staple, snacks, and prudent patterns. The rice staple pattern was associated positively with abdominal obesity in men (prevalence ratio (PR) = 1.358; 95% confidence interval (CI) 1.132-1.639; p = 0.001), but was associated negatively with general obesity in women (PR = 0.745; 95% CI: 0.673-0.807; p = 0.031). Men in the highest quartile of the wheat staple pattern had significantly greater risk of central obesity (PR = 1.331; 95% CI: 1.094-1.627; p = 0.005). There may be gender differences in the association between dietary patterns and obesity in middle-aged and elderly populations in Shanghai, China.

Self-regulation interventions to reduce consumption of sugar-sweetened beverages in adolescents

This study evaluated the efficacy of self-regulation interventions through the use of drink-specific implementation intentions and drink-specific Go/No-Go training tasks as compensatory strategies to modify inhibitory control to reduce intake of sugar-sweetened beverages (SSB). In a between-subjects randomized manipulation of implementation intentions and Go/No-Go training to learn to inhibit sugary drink consumption, 168 adolescents reporting inhibitory control problems over sugary drinks and foods were recruited from high schools in southern California to participate. Analysis of covariance overall test of effects revealed no significant differences between the groups regarding calories consumed, calories from SSBs, grams of sugar consumed from drinks, or the number of unhealthy drinks chosen. However, subsequent contrasts revealed SSB implementation intentions significantly reduced SSB consumption following intervention while controlling for inhibitory control failure and general SSB consumption during observation in a lab setting that provided SSBs and healthy drinks, as well as healthy and unhealthy snacks. Specifically, during post-intervention observation, participants in the sugar-sweetened beverage implementation intentions (SSB-II) conditions consumed significantly fewer calories overall, fewer calories from drinks, and fewer grams of sugar. No effects were found for the drink-specific Go/No-Go training on SSB or calorie consumption. However, participants in SSB-II with an added SSB Go/No-Go training made fewer unhealthy drink choices than those in the other conditions. Implementation intentions may aid individuals with inhibitory (executive control) difficulties by intervening on pre-potent behavioral tendencies, like SSB consumption.

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.

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.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

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.

"What do you think of when I say the word 'snack'?" Towards a cohesive definition among low-income caregivers of preschool-age children

Despite agreement that snacks contribute significant energy to children's diets, evidence of the effects of snacks on health, especially in children, is weak. Some of the lack of consistent evidence may be due to a non-standardized definition of snacks. Understanding how caregivers of preschool-aged children conceptualize and define child snacks could provide valuable insights on epidemiological findings, targets for anticipatory guidance, and prevention efforts. Participants were 59 ethnically-diverse (White, Hispanic, and African American), low-income urban caregivers of children age 3-5 years. Each caregiver completed a 60-90 min semi-structured in-depth interview to elicit their definitions of child snacks. Data were coded by two trained coders using theoretically-guided emergent coding techniques to derive key dimensions of caregivers' child snack definitions. Five interrelated dimensions of a child snack definition were identified: (1) types of food, (2) portion size, (3) time, (4) location, and (5) purpose. Based on these dimensions, an empirically-derived definition of caregivers' perceptions of child snacks is offered: A small portion of food that is given in-between meals, frequently with an intention of reducing or preventing hunger until the next mealtime. These findings suggest interrelated dimensions that capture the types of foods and eating episodes that are defined as snacks. Child nutrition studies and interventions that include a focus on child snacks should consider using an a priori multi-dimensional definition of child snacks.

Snacking Behavior and Obesity among Female Adolescents in Isfahan, Iran

BACKGROUND AND OBJECTIVE

The high prevalence of obesity in the pediatric age groups draws attention to lifestyle factors including diet and physical activity. Data on obesity in adolescents and their snacking behavior are conflicting. This study aimed to assess the association of snacking behavior and obesity among female adolescents in Isfahan, Iran.

SUBJECTS AND DESIGN

This cross-sectional study was carried out on 265 female Isfahanian students who were chosen by systematic cluster random sampling. Dietary intake was assessed using a validated self-administered semiquantitative food frequency questionnaire that included 53 food items. Snacking behavior was defined by healthy snack score in combination with the frequency of snack intake.

RESULTS

Individuals who consumed more healthy snacks and those with snacking frequency of 4 times a day or more had significantly lower weight, body mass index (BMI), and waist circumference (p < 0.001). Decreased consumption of healthy snacks was significantly associated with a greater chance of being overweight, generally obese, and abdominally obese among adolescents (odds ratio [OR] = 1.98; 95% confidence interval [CI], 1.00-3.14, ptrend = 0.04 and OR = 2.10; 95% CI, 1.01-3.13, ptrend = 0.04, respectively). Frequency of snack intake was inversely related to overweight, general obesity, and abdominal obesity (OR = 3.23; 95% CI, 1.73-5.61, ptrend = 0.03 and OR = 1.84; 95% CI, 1.05-3.20, ptrend = 0.04, respectively). Healthy snack score in combination with frequency of snacking showed that those in the lowest tertile of snacking who consumed snacks less than 4 times/day had the highest risk of obesity compared to other categories (OR = 2.09, 95% CI, 1.11-3.20, p < 0.001).

CONCLUSION

More frequent consumption of healthy snacks is associated with decreased prevalence of overweight, general obesity, and abdominal obesity in adolescents. Further studies, in particular of a prospective nature, are required to examine this association in other populations.

Decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity: a cross-sectional study in British children and adolescents

Evidence of associations between meal frequency (MF) and snack frequency (SF) and diet and obesity in young populations is limited. This cross-sectional study examined MF and SF in relation to dietary intake and adiposity measures in British children aged 4-10 years (n 818) and adolescents aged 11-18 years (n 818). Based on data from a 7-d weighed dietary record, all eating occasions were divided into meals or snacks on the basis of contribution to energy intake (≥15 or <15 %) or time (06.00-10.00, 12.00-15.00 and 18.00-21.00 hours or others). All measures of MF and SF showed positive associations with energy intake, except for MF based on energy contribution in children. Irrespective of the definition of snacks, SF was associated with higher intakes of soft drinks, confectionery and total sugar, lower intakes of cereals, fish, meat, protein, PUFA, starch and dietary fibre, and a lower diet quality (assessed by the Mediterranean diet score, except for SF based on energy contribution in adolescents). MF based on time, but not based on energy contribution, was associated with higher intakes of confectionery and total sugar, lower intakes of fish, protein, PUFA and starch, and, only in children, a lower diet quality. All measures of MF and SF showed no association with adiposity measures. In conclusion, this cross-sectional study in British children and adolescents suggests that decreasing the number of small eating occasions (<15 % of total energy intake) regardless of the time of day may be important to improve diet quality but not adiposity.

Neighborhood availability of convenience stores and diet quality: findings from 20 years of follow-up in the coronary artery risk development in young adults study

OBJECTIVES

We examined the association between neighborhood convenience stores and diet outcomes for 20 years of the Coronary Artery Risk Development in Young Adults study.

METHODS

We used dietary data from the Coronary Artery Risk Development in Young Adults study years 1985-1986, 1992-1993, and 2005-2006 (n = 3299; Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA) and geographically and temporally matched neighborhood-level food resource and US Census data. We used random effects repeated measures regression to estimate associations between availability of neighborhood convenience stores with diet outcomes and whether these associations differed by individual-level income.

RESULTS

In multivariable-adjusted analyses, greater availability of neighborhood convenience stores was associated with lower diet quality (mean score = 66.3; SD = 13.0) for participants with lower individual-level income (b = -2.40; 95% CI = -3.30, -1.51); associations at higher individual-level income were weaker. We observed similar associations with whole grain consumption across time but no statistically significant associations with consumption of sugar-sweetened beverages, artificially sweetened beverages, snacks, processed meats, fruits, or vegetables.

CONCLUSIONS

The presence of neighborhood convenience stores may be associated with lower quality diets. Low-income individuals may be most sensitive to convenience store availability.