Meals and snacking, diet quality and energy balance

Socio-economic and demographic factors associated with snacking behavior in a large sample of French adults

Background

Few studies have specifically focused on demographic and socio-economic characteristics associated with snacking in adults, whereas their identification could be useful for defining effective public health measures. The aim of our study was to assess the associations of these factors with daily snacking behavior and its dietary quality.

Methods

This cross-sectional study included 84,692 women and 23,491 men from the NutriNet-Santé cohort study. Occurrence of snacking, energy intake from snacks, snack nutrient, and energy densities were assessed using 24-h dietary records of weekdays at baseline. Associations between socio-economic and demographic factors (age, presence of children in the household, education, income, occupation), and snacking behavior were examined using multivariable logistic regression and analysis of covariance, stratified by sex and adjusted for total daily energy intake.

Results

Older individuals were more likely to snack during the day in both sexes while individuals with primary education (OR = 0.79 (0.71;0.87) in women; OR = 0.71 (0.60;0.83) in men), female employees (OR = 0.94 (0.89;0.99), and self-employed women were less likely to snack during the day. Older individuals, in particular middle-aged subjects, had higher snack nutrient density, and lower energy intake and density from snacks compared with younger adults. Presence of a child in the household was associated with higher energy density, lower nutrient density (in women), and lower energy intake from snacks (in men), compared with those who lived without a child in household. In low income individuals and manual workers, snacks had lower nutrient density and higher energy content than in higher socioeconomic categories. At last, energy intake from daily snacking occasions was higher in women with low education level.

Conclusions

Although snacking was less prevalent in low socioeconomic categories and young adults, their snacks had higher energy content and were of poorer nutrient density. Such findings provide useful information on mechanisms of social disparities in dietary behavior.

Trial registration

This study was conducted according to the guidelines laid down in the Declaration of Helsinki. All procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No.908450 and No.909216). Clinical Trial no. NCT03335644

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0655-7) contains supplementary material, which is available to authorized users.

Physical activity-equivalent label reduces consumption of discretionary snack foods

OBJECTIVE

The present research aimed to investigate the impact of the physical activity calorie equivalent (PACE) front-of-pack label on consumption, prospective consumption and liking of familiar and unfamiliar discretionary snack foods.

DESIGN

In a within-subject randomised design, participants tasted and rated liking (9-point hedonic scale) and prospective consumption (9-point category scale) of four different snack foods with four different labels (i.e. blank, fake, PACE, PACE doubled) and four control snack foods. The twenty snack foods were presented during two 45 min sessions (i.e. ten snack foods per session) which were separated by one week. The amount participants sampled of each snack food was measured.

SETTING

The study was conducted in the Centre for Advanced Sensory Sciences laboratory at Deakin University, Australia.

SUBJECTS

The participants were 153 university students (126 females, twenty-seven males, mean age 24·3 (sd 4·9) years) currently enrolled in an undergraduate nutrition degree at Deakin University.

RESULTS

When the PACE label was present on familiar snack foods, participants sampled 9·9 % (22·8 (sem 1·4) v. 25·3 (sem 1·5) g, P=0·03) less than when such label was not present. This was in line with a decreased prospective snack food consumption of 9·1 % (3·0 (sem 0·2) v. 3·3 (sem 0·2) servings, P=0·03). Such pattern was not seen in unfamiliar snacks.

CONCLUSIONS

The PACE label appears to be a promising way to decrease familiar discretionary snack food consumption in young, health-minded participants.

Energy, nutrient and food content of snacks in French adults

Background

Snacking raises concern since it may lead to an additional energy intake and poor nutrient quality. A snacking occasion can be defined as any eating occasion apart from main meals, regardless of the amount or type of foods consumed. We described the frequency of snacking occasions according to daily timing in French adults, and compared them between each other, and with the main meals, in terms of energy intake, energy and nutrient density, and food content.

Methods

This cross-sectional analysis included 104,265 adults from the NutriNet-Santé cohort. Food intake was estimated using 24-h records of weekdays. For each eating occasion, nutrient density and energy content and density were computed.

Results

After weighting, 47.6% of our sample were men and mean age was 45.6 (15.3). Overall, 68% of participants ate at least one snack during the reported record, mainly in the morning or afternoon. Overall snack had a lower nutrient density [22.8 (SD = 278.3)] than main meals [25.8 (36.9) to 30.0 (30.4)]; but higher energy density [222.2 (163.3) kcal/100 g] than meals [133.9 (57.3) to 175.9 (99.6) kcal/100 g]. Morning snack was the snacking occasion with the lowest energy density [211 kcal/100 g], the lowest energy intake [104.1 kcal] and the highest nutrient density [60.1]. Afternoon and evening snacks had the highest energy loads [192.4 kcal and 207.6 kcal], but low nutrient scores [16 and 13, respectively]. The main food groups contributing to energy intake from snacks were fatty-sweet and sugary foods, fruit, hot beverages, and bread.

Conclusions

Our findings highlight the frequency of snacking and the varying nutritional quality of snacks over the day. The morning snack was shown to be healthier than afternoon and evening snacks.

Trial registration

This study was conducted according to guidelines laid down in the Declaration of Helsinki, and all procedures were approved by the Institutional Review Board of the French Institute for Health and Medical Research (IRB Inserm No. 0000388FWA00005831) and the French Data Protection Authority (Commission Nationale Informatique et Libertés No. 908450 and No. 909216). Electronic informed consent was obtained from all participants (Clinical Trial no. NCT03335644).

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0336-z) contains supplementary material, which is available to authorized users.

Prevalence and factors associated with overweight and obesity among children from primary schools in urban areas of Lomé, Togo

Objective

Overweight and obesity in childhood are serious public health issues, both in developing and developed countries. The present study aimed to ascertain overweight and obesity prevalence rates among Togolese schoolchildren in Lomé, Togo, and their correlation with physical activity, socio-economic conditions and eating habits.

Design

Cross-sectional survey conducted in December 2015. Overweight and obesity were defined using age- and sex-specific BMI cut-off points of the International Obesity Task Force. Physical activity, socio-economic conditions and eating habits were assessed with a standardized questionnaire. Specially trained medical students interviewed children and collected the data. After bivariate regression analyses, factors associated with overweight/obesity were identified by multivariate logistic regression. Statistical significance was two-sided P<0·05.

Setting

Lomé, Togo.

Subjects

Representative sample of 634 children (288 boys, 346 girls), aged 8–17 years, who were studying in primary schools.

Results

Overweight and obesity respectively affected 5·2 and 1·9 % of children surveyed. Watching television (>4 h) on weekends (OR; 95 % CI: 3·8; 1·2, 12·0, P=0·02) and medium dietary diversity score (3·0; 1·1, 8·1, P=0·03) were independently associated with overweight/obesity in a multivariate regression model. Eating breakfast in the school cafeteria (0·2; 0·1, 0·8, P=0·03) and eating fruits (0·4; 0·1, 0·9, P=0·03) significantly reduced the risk of overweight/obesity.

Conclusions

Overweight and obesity prevalence were linked with sedentary behaviour and non-optimal food diversity. Promoting physical activity and fruit consumption should be explored as interventions to reduce and prevent overweight and obesity in Lomé schoolchildren. In addition, preventive approaches in the social environment of children should be considered.

Dietary Management of Obesity: Cornerstones of Healthy Eating Patterns

Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss.

Increased Protein Consumption during the Day from an Energy-Restricted Diet Augments Satiety but Does Not Reduce Daily Fat or Carbohydrate Intake on a Free-Living Test Day in Overweight Women

Background: Higher-protein (HP) energy-restriction diets improve weight management to a greater extent than normal-protein (NP) versions. Potential mechanisms of action with regard to assessment of eating behaviors across the day have not been widely examined during energy restriction.Objectives: The objectives of this study were to test whether the consumption of an HP energy-restriction diet reduces carbohydrate and fat intakes through improvements in daily appetite, satiety, and food cravings compared with NP versions and to test whether protein type within the NP diets alters protein-related satiety.Methods: Seventeen overweight women [mean ± SEM age: 36 ± 1 y; body mass index (kg/m2): 28.4 ± 0.1] completed a randomized, controlled-feeding crossover study. Participants were provided with the following ∼1250-kcal/d energy-restricted (-750-kcal/d deficit) diets, each for 6 d: HP [124 g protein/d; 60% from beef and 40% from plant sources (HP-BEEF)] or NP (48 g protein/d) that was protein-type matched (NP-BEEF) or unmatched [100% from plant-based sources (NP-PLANT)]. On day 6 of each diet period, participants completed a 12-h testing day containing repetitive appetite, satiety, and food-craving questionnaires. On day 7, the participants were asked to consume their protein requirement within each respective diet but were provided with a surplus of carbohydrate- and fat-rich foods to consume, ad libitum, at each eating occasion across the day. All outcomes reported were primary study outcomes.Results: The HP-BEEF diet reduced daily hunger by 16%, desire to eat by 15%, prospective food consumption by 14%, and fast-food cravings by 15% but increased daily fullness by 25% compared with the NP-BEEF and NP-PLANT diets (all P < 0.05). However, consuming more protein throughout the day did not reduce the energy consumed ad libitum from the fat- and carbohydrate-rich foods (HP-BEEF: 2000 ± 180 kcal/d; NP-BEEF: 2120 ± 190 kcal/d; NP-PLANT: 2070 ± 180 kcal/d). None of the outcomes differed between the NP-BEEF and NP-PLANT treatments.Conclusions: Although appetite control, satiety, and food cravings improved after an HP energy-restriction diet, increased protein consumption did not reduce carbohydrate and fat intakes throughout the free-living test day in overweight healthy women exposed to highly palatable foods. This trial was registered at clinicaltrials.gov as NCT02614729.

Weekday snacking prevalence, frequency, and energy contribution have increased while foods consumed during snacking have shifted among Australian children and adolescents: 1995, 2007 and 2011-12 National Nutrition Surveys

Background

There are limited data on the evolution of eating habits, including snacking, in Australia. This study aimed to understand snacking trends among Australian children over three previous National Nutrition Surveys.

Methods

Data were analysed from a single weekday 24-h recall in the National Nutrition Surveys 1995, 2007, 2011–12 among children 2-16y (n = 8258). A snacking occasion was defined as an eating occasion that occurred between meals based on time of day.

Results

The percentage of children snacking increased over time (92.5 ± 0.5(SE) % in 1995, 98.1 ± 0.3% in 2007, and 95.8 ± 0.4% in 2011–12) (P < 0.001), particularly among those having four or more snacking occasions (7.1 ± 0.5% in 1995, 17.9 ± 0.6% in 2007, and 18.5 ± 0.8% in 2011–2) (P < 0.001). The mean number of snacking occasions increased from 2.0 ± 0.0 in 1995, to 2.5 ± 0.0 in 2007 and 2011–12 (P < 0.001). The energy contribution from snacking increased from 24.1 ± 0.3% in 1995 to 27.7 ± 0.3% in 2007 and 30.5 ± 0.4% in 2011–12 (P < 0.001), while the energy from discretionary food during snacking decreased from 56.5 ± 0.7% in 1995 to 47.3 ± 0.5% in 2007 and 47.9 ± 0.7% in 2011–12 (P < 0.001). There were differences in the top foods consumed during snacking: non-alcoholic beverages were prominent contributors in 1995 but not in 2007 or 2011, and pome fruit was the second top energy contributor during snacking in 2007 and 2011 but only fourth in 1995.

Conclusions

Snacking is a prominent dietary pattern that has increased over time in frequency and energy contribution. Foods and beverages consumed during snacking occasions include a mix of core foods and discretionary foods, and while the contribution of discretionary foods has decreased, there is still an opportunity to encourage consumption of more nutrient dense foods during snacking.

Electronic supplementary material

The online version of this article (10.1186/s12937-017-0288-8) contains supplementary material, which is available to authorized users.

Dietary habits and sedentary behaviors among health science university students in Bahrain

OBJECTIVE

The aim of this study was to investigate the dietary patterns and sedentary behaviors among university students in Bahrain.

MATERIALS AND METHODS

A cross-sectional study was carried out with students of the College of Health Sciences in Bahrain using a self-reported questionnaire. All the students enrolled in this college were included in this study (642 students; 90 males and 552 females). The mean age of the sample was 20.1±2.0 years. A pre-tested questionnaire was used to collect information on the students' breakfast intake, snacking, food frequency intake, and sedentary habits.

RESULTS

More than 50% of the students did not consume breakfast on a daily basis. A statistically significant difference (p<0.003) was found between males (19%) and females (35%) in relation to the intake of an afternoon snack. There were no significant gender differences regarding frequency of food intake, except for carbonated beverages (p<0.001) and nuts (p<0.047) consumption. Females were more likely than males to spend time watching television, use the Internet, use a mobile phone and sleep; however, the only significant difference found was for Internet use (p<0.003). Being physically active on a daily basis was more prevalent among males (41.6%) than females (16%) (p<0.001). Females (42.9%) were more prone to sleep for less time (<7 h) than males (34.4%)(p<0.08).

CONCLUSION

The findings indicated that a high percentage of health science students in Bahrain had unhealthy dietary habits and sedentary behaviors. Thus, an intervention program to promote healthy dietary patterns and lifestyle habits among university students is highly recommended.

Snacking Patterns of Preschool-Aged Children: Opportunity for Improvement

PURPOSE

Dietary patterns established in childhood track into adulthood. Despite this, little research has explored preschoolers' snacking. This study examined snacking patterns (frequency, quality, quantity) of preschool-aged boys and girls.

METHODS

Cross-sectional data were collected on 52 children (23 males; 3.4 ± 1.1 years of age; BMI 16.1 ± 1.4 kg/m²) enrolled in the Guelph Family Health Study pilot. Parent-reported 3-day food records were analyzed for children's snacking patterns including frequency (number of snacking occasions per day), quantity (percent energy from snacks) and quality (inclusion of food groups from Eating Well with Canada's Food Guide, macronutrient distribution, sugary and salty snacks). Mann-Whitney U tests examined sex differences in snacking patterns.

RESULTS

Ninety-six percent of children snacked daily, consuming a mean of 2.3 ± 0.7 snacks per day. Snacks accounted for one-third of daily energy. 78% of boys' versus 63% of girls' snacks contained a food group (P = 0.016). Boys consumed significantly fewer sugary snacks (0.5 ± 0.4 vs 0.9 ± 0.6 snacks per day, P = 0.016), although the percent of snack calories from sugar for both boys and girls was high (group mean 37.2 ± 6.7%).

CONCLUSIONS

Nearly all preschoolers in this study snacked daily, and consumed a variety of snack foods. Boys' and girls' snacking preferences begin to diverge early in life. Preschool children should be encouraged to consume healthful snacks.

Healthy Snacks: Using Nutrient Profiling to Evaluate the Nutrient-Density of Common Snacks in the United States

OBJECTIVE

To quantify and compare the nutrient-density of commonly consumed snacks using two nutrient-density measures, Nutrient Rich Foods Indices 9.3 (NRF 9.3) and 15.3 (NRF 15.3).

DESIGN

Identify commonly consumed categories of snacks and individual snack foods, calculate NRF 9.3 and 15.3 scores, rank snacks by category and by individual food based on nutrient density, compare and contrast scores generated by the two NRF Indices.

MAIN OUTCOME MEASURES

NRF 9.3 and 15.3 scores.

ANALYSIS

Averages and standard deviations of nutrient-density scores for each snack category.

RESULTS

Vegetables and coffee/tea received the highest category scores on both indices. Cakes/cookies/pastries and sweets had the lowest category scores. NRF 9.3 scores for individual snacks ranged from -46 (soda) to 524 (coffee). NRF 15.3 scores ranged from -45 (soda) to 736 (coffee).

CONCLUSIONS AND IMPLICATIONS

If added to food labels, NRF scores could help consumers identify more nutritious choices. The differences between NRF 9.3 and 15.3 scores generated for the same foods and the limitations of these indices highlight the need for careful consideration of which nutrient-density measure to include on food labels as well as consumer education.

Objective quantification of the food proximity effect on grapes, chocolate and cracker consumption in a Swedish high school. A temporal analysis

Close food proximity leads to increased short-term energy intake, potentially contributing to the long-term development of obesity. However, its precise effects on eating behaviour are still unclear, especially with food available for extended periods of time. This study involved two similar high school student groups (15–17 years old), which had ad libitum access to grapes, chocolates and crackers during an hour-long experimental session. In the distal condition the foods were placed 6 meters away from the students (n = 24), in contrast to the proximal condition (n = 17) were the food was placed near the students. The identification of the type and the quantification of the amount of each food selected, for each individual serving, was facilitated through use of food scales and video recording. In the proximal condition individuals served themselves grapes and crackers more often and consumed more chocolate than in the distal condition. In total, participants in the proximal condition ingested significantly more energy (726 kcal vs. 504 kcal; p = 0.029), without reporting higher fullness. Food proximity also affected the temporal distribution of servings, with the first five minutes of the sessions corresponding to 53.1% and 45.6% of the total energy intake for the distal and proximal conditions, respectively. After the first five minutes, the servings in the distal condition were strongly clustered in time, with many students getting food together. In the proximal condition however, students displayed an unstructured pattern of servings over time. In conclusion, this study strengthens past evidence regarding the important role of food proximity on individual energy intake and, for the first time, it associates continuous food proximity to the emergence of unstructured eating over time. These conclusions, expanded upon by future studies, could support the creation of meaningful intervention strategies based on spatially and temporally controlled food availability.

Feeding styles, parenting styles and snacking behaviour in children attending primary schools in multiethnic neighbourhoods: a cross-sectional study

OBJECTIVE

The aim of the present study was to investigate whether feeding styles and parenting styles are associated with children's unhealthy snacking behaviour and whether the associations differ according to children's ethnic background.

METHOD

Cross-sectional data from the population-based 'Water Campaign' study were used. Parents (n=644) of primary school children (6-13 years) completed a questionnaire covering sociodemographic characteristics, feeding style dimensions ('control over eating', 'emotional feeding', 'encouragement to eat' and 'instrumental feeding'), parenting style dimensions ('involvement' and 'strictness') and children's unhealthy snacking behaviour. Logistic regression analyses were performed to determine whether feeding styles and parenting styles were associated with children's unhealthy snacking behaviour.

RESULT

Overall, children whose parents had a higher extent of 'control over eating' had a lower odds of eating unhealthy snacks more than once per day (OR, 0.57; 95% CI 0.42 to 0.76). Further stratified analysis showed that 'control over eating' was associated with less unhealthy snacking behaviour only in children with a Dutch (OR, 0.37; 95% CI 0.20 to 0.68) or a Moroccan/Turkish (OR, 0.44; 95% CI 0.25 to 0.77) ethnic background. 'Encouragement to eat' was associated with a lower odds of eating unhealthy snacks every day in children with a Dutch ethnic background only (OR, 0.48; 95% CI 0.25 to 0.90). 'Instrumental feeding' was associated with a higher odds of eating unhealthy snacks more than once a day in children with a Moroccan/Turkish ethnic background only (OR, 1.43; 95% CI 1.01 to 2.04).

CONCLUSION

Our results suggest that 'control over eating' may be associated with less unhealthy snack consumption in children. The associations of feeding styles and parenting styles with children's unhealthy snacking behaviour differed between children with different ethnic backgrounds.

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.

Energy and macronutrient intake over the course of the day of German adults: A DEDIPAC-study

The aim of the study was to analyze the energy and macronutrient intake over the course of the day of selected population groups in Germany defined by sex, age, BMI, SES, and diet quality. The study was based on food consumption data from the German National Nutrition Survey II (2005-2007) assessed by two 4-day dietary weighing records of 662 women and men aged between 18 and 80 years. Energy and macronutrient intake were calculated using the German Nutrient Database 3.02 and summarized for the periods 'morning', 'midday', 'afternoon', 'evening', and 'night'. Generalized estimating equation models were used to examine differences in energy and macronutrient intake. For women and men, a three-main-meal pattern ('morning', 'midday', and 'evening') was observed, indicated as peaks in energy intake at 08:00 to 09:00, 13:00 and 19:00 o'clock. The distributions of carbohydrate, protein, and fat intake mirror the distribution of energy intake over the course of the day. The highest energy intake was found in the 'evening' period, especially in young adults, overweight persons, persons with a high SES, and men with a low diet quality. Women of the oldest age group showed a similar energy intake across the three-main-meals in contrast to young adults, who had lower peaks in the 'morning' and 'midday' periods as well as a shift to later meal times. Young adults seem to have a higher variability in energy intake and a less distinct meal pattern, while seniors have a more structured day. Because a high energy intake in the 'evening' period is associated with negative health-related factors, the distribution of energy intake should be considered by recommendations for a healthy nutritional behavior.

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.

Effects of a healthier snack on snacking habits and glycated Hb (HbA1c): a 6-week intervention study

Dietary behaviour modification may change eating habits and reduce the impact of poor nutrition. This study aimed to evaluate the effects of daily consumption of a healthier snack bar on snacking habits and glycated Hb (HbA1c) within a 6-week intervention. In all, twenty-eight participants were randomly allocated to two groups to either consume the bars as the main snack for 6 weeks (n 14) or receipt of the bars was delayed for 6 weeks (n 14) following a stepped-wedge design. All participants had HbA1c concentrations measured at weeks -1, 0, 4, 6, 10 and 12. A short dietary habits questionnaire was self-completed at weeks 0, 6 and 12. Participants consumed the bars they received instead of other snacks, and found that the healthier snack bar was acceptable as part of their daily dietary pattern. Over the 12 weeks, there was a significant reduction in intake of biscuits, cakes and pies (approximately 2 servings/week, P<0·05) in both groups. Fruit juice intake was reduced (approximately 1 serving/week, P=0·029) in the first group. In all, twenty participants (71·4 %) experienced a decrease (n 15) or no change (n 5) in HbA1c (range 0-4 mmol/mol), whereas eight participants experienced an increase in HbA1c (range 0·5-2·5 mmol/mol). There was high compliance with the healthier snack intervention and a trend towards a favourable effect on glucose homoeostasis. Habitual snacking behaviour has the potential to be improved through changes in the food supply, and in the longer term may reduce the impact of poor nutrition on public health.

Intuitive Eating Dimensions Were Differently Associated with Food Intake in the General Population-Based NutriNet-Santé Study

BACKGROUND

Intuitive eating (IE) is characterized by eating in response to physiological hunger and satiety cues rather than emotional cues and not considering certain foods to be forbidden. Evidence supports an inverse association of IE with body mass index (BMI), but little is known about its association with food intake.

OBJECTIVE

We aimed to examine the relation between IE and food intake in a large sample from the general adult population.

METHODS

A total of 9581 men and 31,955 women aged ≥18 y participating in the NutriNet-Santé cohort were included in this cross-sectional analysis. IE was assessed by using the validated French version of the Intuitive Eating Scale-2 (modeled in quartiles). Food intake was assessed by using ≥6 self-reported 24-h dietary records (2009-2015). The associations between IE subscales (Eating for Physical rather than Emotional Reasons, referred to as Physical Reasons; Reliance on Hunger and Satiety Cues, referred to as Cues; and Unconditional Permission to Eat, referred to as Permission) and food intake were assessed by using multiple linear and logistic regression models.

RESULTS

In women, higher Physical Reasons and Cues scores were associated with lower energy intake (P < 0.0001). Also, a higher Physical Reasons score was associated with lower sweet- and fatty-food intake in both women (143 g/d in quartile 1 compared with 124 g/d in quartile 4) and men (153 compared with 138 g/d) and lower intakes of dairy products and meat, fish, and eggs in women (all P < 0.0001). A higher Cues score was associated with a lower intake of dairy products and meat, fish, and eggs in both sexes and a higher whole-grain intake in women (all P < 0.0001). In contrast, higher Permission scores were associated with a higher energy intake and unhealthier intake, including lower fruit, vegetable, and whole-grain intake (all P < 0.0001).

CONCLUSIONS

IE dimensions such as Physical Reasons and Cues subscales were associated with healthier dietary intakes overall, whereas the Permission dimension was associated with unhealthier dietary intakes. From a public health perspective, these findings suggest the importance of developing strategies to promote eating in response to hunger and satiety signals. This study was registered at eudract.ema.europa.eu as 2013-000929-31.

Dietary patterns associated with overweight and obesity among Brazilian schoolchildren: an approach based on the time-of-day of eating events

Several studies reported that the timing of eating events has critical implications in the prevention of obesity, but dietary patterns regarding the time-of-day have not been explored in children. The aim of this study was to derive latent food patterns of daily eating events and to examine their associations with overweight/obesity among schoolchildren. A population-based cross-sectional study was conducted with 7–10-year-old Brazilian schoolchildren (n 1232) who completed the Previous Day Food Questionnaire, illustrated with twenty-one foods/beverages in six daily eating events. Latent class analysis was used to derive dietary patterns whose association with child weight status was evaluated by multivariate multinomial regression. Four mutually exclusive latent classes of dietary patterns were identified and labelled according to the time-of-day of eating events and food intake probability (FIP): (A) higher FIP only at lunch; (B) lower FIP at all eating events; (C) higher FIP at lunch, afternoon and evening snacks; (D) lower FIP at breakfast and at evening snack, higher FIP at other meals/snacks. The percentages of children within these classes were 32·3, 48·6, 15·1 and 4·0 %, respectively. After controlling for potential confounders, the mean probabilities of obesity for these classes were 6 % (95 % CI 3·0, 9·0), 13 % (95 % CI 9·0, 17·0), 12 % (95 % CI 6·0, 19) and 11 % (95 % CI 5·0, 17·0), in the same order. In conclusion, the children eating traditional lunch with rice and beans as the main meal of the day (class A) had the lowest obesity risk, thus reinforcing the importance of both the food type and the time-of-day of its intake for weight status.

Lifestyle counseling in overweight truck and bus drivers - Effects on dietary patterns and physical activity

We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling.

TRIAL REGISTRATION

Clinical Trials NCT00893646.

Meal patterns across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study

OBJECTIVE

To characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study.

DESIGN

Cross-sectional study utilizing dietary data collected through a standardized 24 h diet recall during 1995-2000. Eleven predefined intake occasions across a 24 h period were assessed during the interview. In the present descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion.

SETTING

Twenty-seven centres across ten European countries.

SUBJECTS

Women (64 %) and men (36 %) aged 35-74 years (n 36 020).

RESULTS

Pronounced differences in meal patterns emerged both across centres within the same country and across different countries, with a trend for fewer intake occasions per day in Mediterranean countries compared with central and northern Europe. Differences were also found for daily energy intake provided by lunch, with 38-43 % for women and 41-45 % for men within Mediterranean countries compared with 16-27 % for women and 20-26 % for men in central and northern European countries. Likewise, a south-north gradient was found for daily energy intake from snacks, with 13-20 % (women) and 10-17 % (men) in Mediterranean countries compared with 24-34 % (women) and 23-35 % (men) in central/northern Europe.

CONCLUSIONS

We found distinct differences in meal patterns with marked diversity for intake frequency and lunch and snack consumption between Mediterranean and central/northern European countries. Monitoring of meal patterns across various cultures and populations could provide critical context to the research efforts to characterize relationships between dietary intake and health.

Snacking Among US Children: Patterns Differ by Time of Day

OBJECTIVE

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

DESIGN

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

PARTICIPANTS

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

VARIABLES MEASURED

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

ANALYSIS

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

RESULTS

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

CONCLUSIONS AND IMPLICATIONS

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

Chronic Stress Is Associated with Indicators of Diet Quality in Habitual Breakfast Skippers

BACKGROUND

Previous studies suggest skipping breakfast is associated with lower diet quality, but possible reasons underlying this relationship are not clear.

OBJECTIVE

Our aim was to determine the relationship between chronic stress and variations in diet quality in the context of breakfast eating or breakfast skipping.

DESIGN

Based on morning eating habits, 40 breakfast eaters and 35 breakfast skippers participated in a cross-sectional study. Diet assessment was based on unannounced 24-hour recalls.

PARTICIPANTS/SETTING

Women, ages 18 to 45 years, with a body mass index (calculated as kg/m²) <40 were recruited in the greater Sacramento, CA, area between 2009 and 2013. Only women who consistently ate or skipped breakfast were enrolled.

MAIN OUTCOME MEASURES

Compliance with the 2010 Dietary Guidelines for Americans was measured using the Healthy Eating Index 2010 (HEI-2010). Stress and executive function were evaluated with validated questionnaires and a computer-based task, respectively.

STATISTICAL ANALYSES PERFORMED

Diet characteristics of breakfast eating and breakfast skipping were evaluated as nutrient densities (amounts per 1,000 kcal) and compared using a one-way analysis of covariance, with body mass index as covariate. Diet and stress variable associations were assessed using Pearson correlations.

RESULTS

Despite no observed differences in daily energy intake between breakfast skipping and breakfast eating, overall diet quality (P=0.001), whole grains (P=0.002), fruit (P=0.002), empty calories (P=0.050), fiber (P=0.001), calcium (P=0.001), potassium (P=0.033), and folate (P=0.013) intakes were higher in breakfast eating. In the evening, breakfast skipping consumed more added sugars (P=0.012) and saturated fat (P=0.006). In breakfast skipping, reported stress was associated with empty calories (r=-0.39; P=0.027) and evening intake of added sugars (r=0.501; P=0.005). These relationships were not observed in breakfast eating.

CONCLUSIONS

Breakfast skippers were less likely to meet the Dietary Guidelines for Americans and consumed more empty calories at night. Chronic stress was related to evening eating choices and overall empty calories in the diet of breakfast skippers, whereas breakfast eaters' dietary intake did not appear to be affected by chronic stress.

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.

Palatable Eating Motives Scale in a college population: Distribution of scores and scores associated with greater BMI and binge-eating

The main goal of this study was to provide distributive data for the Palatable Eating Motives Scale (PEMS) on a large (N=1947) ethnically-diverse college student population along with motive scores characteristic of obesity and binge-eating severity. Students completed the PEMS, or a revised version of the PEMS, the Binge Eating Scale, and reported height and weight for a body mass index (BMI). The PEMS identified Coping, Reward Enhancement, Social, and Conformity motives for eating tasty but unhealthy foods for reasons other than hunger. The revised PEMS (included here) had better goodness-of-fit with the motives. Percentile rankings are presented for each of the motive scores. Separate Coping scores are presented for females and males given a modest effect size for females to score higher. Generally, scores on Coping, Reward Enhancement, Conformity, and a total PEMS score in the 70th percentile (those scoring higher than 70% of the sample) were associated with obesity and severe binge-eating. Unlike these motives, Social scores were the highest at each percentile rank but unassociated with BMI or binge-eating, reflecting the culturally-normative intake of these foods for social reasons. These distribution scores on PEMS motives in college students along with scores linked to higher BMI and binge-eating severity represent the first reported data of this type. Knowledge of these scores can be used to individualize and correspondingly improve current strategies aimed at preventing and treating obesity, binge-eating, maladaptive use of food to regulate internal and external pressures, and to improve overall nutritional health.

Weight-Related Dietary Behaviors in Young Adults

The origins of the obesogenic environment date back to the early 1980s. This means that young adults i.e., those aged 18 to 35 years, have only ever experienced a food milieu that promotes obesity. Indeed, younger generations are becoming heavier sooner than their parents in developed countries, such as the USA. Young adults demonstrate food consumption patterns and dietary behaviors implicated in an excessive gain of body fat. They are the highest consumers of fast food and sugar-sweetened beverages among adult age groups and the lowest consumers of fruit and vegetables. Younger adults are meal skippers but may consume more energy from snacks than older adults. So that the gains made in stemming obesity in childhood are not undone during young adulthood, prevention programs are needed. This review highlights areas for consideration in planning such programs.

Missing Lunch is Associated with Lower Intakes of Micronutrients from Foods and Beverages among Children and Adolescents in the United States

BACKGROUND

In the United States, the lunch meal contributes more than 20% of the daily intakes of most micronutrients for children and adolescents consuming lunch. Seven percent to 20% of children and adolescents in the United States do not eat lunch on a given day.

OBJECTIVE

To identify differences in total micro- and macronutrient intakes of children consuming and missing lunch on a given day.

DESIGN

Cross-sectional secondary analysis of the combined National Health and Nutrition Examination Surveys 2009-2010 and 2011-2012. Dietary intake was assessed using the first day 24-hour recall of each respondent.

PARTICIPANTS AND SETTINGS

The National Health and Nutrition Examination Survey sample represents the total noninstitutionalized civilian population residing in the United States. The sample used in this study included 4,755 children aged 4 to 18 years with complete data for all analyses.

MAIN OUTCOME MEASURES

Total day, lunch, and nonlunch micronutrients, macronutrients, solid fats, and added sugar intakes were examined.

STATISTICAL ANALYSES PERFORMED

Linear regression models controlling for age, sex, race/ethnicity, household poverty status, and weekend were used to compare dietary intakes of lunch consumers and nonconsumers. Intakes from nonlunch sources were examined to determine the extent to which differences between lunch consumers and nonconsumers could be attributed to the lunch meal.

RESULTS

Missing lunch was associated with lower micronutrient intakes, with the lunch meal primarily responsible for the higher micronutrient intakes of lunch consumers compared with nonconsumers. Missing lunch was also associated with lower energy, fiber, and sodium intakes. Added sugar and solid fat intakes of lunch consumers and nonconsumers were not significantly different.

CONCLUSIONS

This study identifies potential concerns for children missing lunch with respect to micronutrient intakes and shows that the lunches consumed by children in the United States are an important source of essential nutrients, but also less healthful dietary components.

Obesity, Dietary Habits, and Sedentary Behaviors Among Adolescents in Sudan: Alarming Risk Factors for Chronic Diseases in a Poor Country

OBJECTIVE

The aim of this study was to investigate the prevalence of obesity, dietary habits, and sedentary patterns among Sudanese adolescents.

METHODS

A multistage stratified sampling method was used to select 945 adolescents (507 males and 438 females) aged 14 to 18 years, from Khartoum State, Sudan. A self-reported pretested questionnaire was used to collect the data. Overweight and obesity were determined using the International Obesity Task Force standard, which is based on body mass index for sex and age.

RESULTS

Overweight and obesity were growing problems among urban Sudanese adolescents (10.7%). Breakfast was commonly consumed on a daily basis by the majority of adolescents (74.2%), followed by lunch (63.9%) and supper (33.5%). Snacking was not a common practice among these individuals. Vegetables (63.9%) were more frequently consumed (more than 3 days per week) than fruit (30.1%). There were significant differences between genders regarding intake of vegetables (P < .048), chicken (P < .013), dairy products, sweets, nuts, chocolate, and legumes (P < .001 for all). Sedentary behaviors (long duration of television viewing and Internet use) were highly prevalent, and physical activity was rarely practiced (6.8%).

CONCLUSION

The findings indicated that risk factors for diet-related chronic diseases such as unhealthy dietary habits and sedentary behaviors are starting to rise among urban adolescents in Sudan. This creates the need for immediate action to prevent and control these risk factors before these diseases become major public health problems.

Obesity, unhealthy dietary habits and sedentary behaviors among university students in Sudan: growing risks for chronic diseases in a poor country

OBJECTIVE

This study aimed to highlight nutritional status, dietary habits and sedentary patterns among university students in Khartoum state, Sudan.

METHODS

A cross-sectional survey was carried out among 400 university students (183 males and 217 females) from University of Khartoum, Sudan. A pre-validated self-reported questionnaire was used to collect the data. Weight and height were measured and body mass index was used to determine obesity status.

RESULTS

Of the students, 20.5, 14.7, and 1.7 % were underweight, overweight and obese, respectively. The majority of students (85.5 %) consumed breakfast daily. About 45 and 21.8 % of students consumed vegetables and fruit, respectively, on more than 3 days a week. Fast food was consumed significantly more (p < 0.01) for more than 3 days per week by females (44.2 %) than males (27.3 %). Females (42.9 %) were more likely to watch television for 3 h and more per day than males (30.6 %) (p < 0.039). Males (33.9 %) were more prone to sleep for fewer than 7 h per day than females (23 %) (p < 0.016).

CONCLUSION

The health authority in Sudan should not only focus on prevention of malnutrition among children but also should organize programs to promote healthy eating and lifestyle among children and youths to prevent and control alarming risk factors for chronic diseases.

Analysis of Dietary Pattern Impact on Weight Status for Personalised Nutrition through On-Line Advice: The Food4Me Spanish Cohort

Obesity prevalence is increasing. The management of this condition requires a detailed analysis of the global risk factors in order to develop personalised advice. This study is aimed to identify current dietary patterns and habits in Spanish population interested in personalised nutrition and investigate associations with weight status. Self-reported dietary and anthropometrical data from the Spanish participants in the Food4Me study, were used in a multidimensional exploratory analysis to define specific dietary profiles. Two opposing factors were obtained according to food groups’ intake: Factor 1 characterised by a more frequent consumption of traditionally considered unhealthy foods; and Factor 2, where the consumption of “Mediterranean diet” foods was prevalent. Factor 1 showed a direct relationship with BMI (β = 0.226; r² = 0.259; p < 0.001), while the association with Factor 2 was inverse (β = −0.037; r² = 0.230; p = 0.348). A total of four categories were defined (Prudent, Healthy, Western, and Compensatory) through classification of the sample in higher or lower adherence to each factor and combining the possibilities. Western and Compensatory dietary patterns, which were characterized by high-density foods consumption, showed positive associations with overweight prevalence. Further analysis showed that prevention of overweight must focus on limiting the intake of known deleterious foods rather than exclusively enhance healthy products.

Characterizing eating patterns: a comparison of eating occasion definitions

BACKGROUND

To date, many approaches have been used to define eating occasions (EOs). A standard definition for EOs is required to facilitate further research.

OBJECTIVE

In this study, we examined the influence of differing definitions of EOs on the characterization of eating patterns.

DESIGN

Cross-sectional dietary data from two 24-h recalls collected during the 2011-12 Australian National Nutrition and Physical Activity Survey (n = 5242 adults, aged ≥19 y) were analyzed. Eight definitions were applied: participant-identified, time-of-day, and 6 neutral definitions (individual EOs separated by different time intervals and/or an additional energy criterion of 210 kJ). Frequency of and total energy intake from meals, snacks, and all EOs were estimated, as appropriate. Differences were tested by using F tests, stratified by sex and age group. Agreement between different definitions of meal and snack frequencies was assessed by using intraclass correlation coefficients (ICCs). For each definition, linear regression was used to estimate the proportion of variance in total energy intake (kJ) and amount of food intake (g) predicted by frequency of EOs and meals and snacks.

RESULTS

Among both sexes and across all age groups, mean frequencies of meals differed between the participant-identified and time-of-day definitions (mean difference range = 0.1-0.3; P < 0.001). There were statistically significant differences between mean frequencies of EOs across the 6 neutral definitions (P < 0.001). There was good agreement for snacks (men: ICC = 0.89; women: ICC = 0.87) but not meal frequencies (men: ICC = 0.38; women: ICC = 0.36) between the participant-identified and time-of-day definitions. The neutral definition (15-min time interval plus energy criterion) best predicted variance in total energy intake (R(2) range = 19.3-27.8).

CONCLUSIONS

Different approaches to the definition of EOs affect how eating patterns are characterized, with the neutral definition best predicting variance in total energy intake. Further research that examines how different EO definitions affect associations with health outcomes is needed to develop consensus on a standard EO definition.

The effect of snacking and eating frequency on dietary quality in British adolescents

PURPOSE

To describe the effects of number of eating occasions and snacks on dietary quality (DQ), defined as adherence to dietary recommendations.

METHODS

A sample of 884 adolescents (11-18 years) in the UK National Diet and Nutrition Survey (NDNS) were included. The Diet Quality Index for Adolescents (DQI-A) was implemented. The total number of eating occasions and snacks was frequency of food or beverages consumed over 24 h and frequency of foods or beverages consumed outside of the three mealtimes, respectively. Results were generated with and without low-energy food under 210 kJ (50 kcal). Regression models were generated with DQ score as the outcome variable and number of eating occasions and snacks as predictors.

RESULTS

The mean (95 % CI) DQ score was 31.1 % (30.2, 32.0). The mean number of eating occasions and snacks was 7.5 (7.3, 7.7) and 2.6 (2.6, 2.7) times/day, respectively. When low-energy events were excluded, the mean number of eating occasions and snacks reduced to 6.2 (6.1, 6.4) and 2.0 (2.0, 2.1) times/day, respectively. DQ score increased by 0.74 points (0.42, 1.05; p < 0.01) and 0.55 points (-0.08, 0.69; p = 0.17) for total eating occasions and snacks, respectively. When low-energy events were excluded, DQ score increased by 0.30 points (-0.84, 0.69; p = 0.13) for each eating occasion and decreased by 1.20 points (-2.1, -0.3; p < 0.01) for each snack.

CONCLUSION

Eating more frequently improves dietary quality especially if some eating occasions are low in energy. A focus on replacing high-energy snacks with low-energy alternatives rather than reducing the number of eating occasions may result in improved dietary quality in adolescents.

Consuming High-Protein Soy Snacks Affects Appetite Control, Satiety, and Diet Quality in Young People and Influences Select Aspects of Mood and Cognition

BACKGROUND

Data concerning the effects of afternoon snacking on ingestive behavior, mood, and cognition are limited.

OBJECTIVE

The purpose of this study was to compare 1088 kJ of high-protein (HP) or high-fat (HF) afternoon snacks vs. no snacking on appetite, food intake, mood, and cognition in adolescents.

METHODS

Thirty-one healthy adolescents (age: 17 ± 1 y) consumed the following afternoon snacks (in randomized order) for 3 d: HP snack (26 g of protein/6 g of fat per 27 g of carbohydrates), HF snack (4 g of protein/12 g of fat per 32 g of carbohydrates), and no snack (NoS). On day 4 of each treatment, the participants completed an 8-h testing day containing pre- and postsnack appetite questionnaires, food cue-stimulated functional MRI brain scans, mood, cognitive function, and eating initiation. Ad libitum dinner and evening snacks were provided and assessed.

RESULTS

HP, but not HF, delayed eating initiation vs. NoS (P < 0.05). Both snacks reduced appetite vs. NoS (P < 0.001) with HP eliciting greater reductions than HF (P < 0.05). Only HF led to reductions in corticolimbic activation in brain regions controlling food motivation/reward vs. NoS (P < 0.01). Although no treatment differences in daily energy intake were detected, HP led to greater protein consumption than NoS (P < 0.05) and greater protein and lower fat consumption than HF (both, P < 0.05). HP led to fewer HF/high-sugar evening snacks than NoS (P < 0.01) and HF (P = 0.09). Although no treatment effects were detected for mood and cognition, HP tended to reduce confusion-bewilderment (P = 0.07) and increase cognitive flexibility (P = 0.09), whereas NoS reduced tension-anxiety (P < 0.05) and vigor-activity (P < 0.05).

CONCLUSION

Afternoon snacking, particularly on HP soy foods, improves appetite, satiety, and diet quality in adolescents, while beneficially influencing aspects of mood and cognition. This trial was registered at clinicaltrials.gov as NCT01781286.

Understanding meal patterns: definitions, methodology and impact on nutrient intake and diet quality

Traditionally, nutrition research has focused on individual nutrients, and more recently dietary patterns. However, there has been relatively little focus on dietary intake at the level of a ‘meal’. The purpose of the present paper was to review the literature on adults' meal patterns, including how meal patterns have previously been defined and their associations with nutrient intakes and diet quality. For this narrative literature review, a comprehensive search of electronic databases was undertaken to identify studies in adults aged ≥  19 years that have investigated meal patterns and their association with nutrient intakes and/or diet quality. To date, different approaches have been used to define meals with little investigation of how these definitions influence the characterisation of meal patterns. This review identified thirty-four and fourteen studies that have examined associations between adults' meals patterns, nutrient intakes and diet quality, respectively. Most studies defined meals using a participant-identified approach, but varied in the additional criteria used to determine individual meals, snacks and/or eating occasions. Studies also varied in the types of meal patterns, nutrients and diet quality indicators examined. The most consistent finding was an inverse association between skipping breakfast and diet quality. No consistent association was found for other meal patterns, and little research has examined how meal timing is associated with diet quality. In conclusion, an understanding of the influence of different meal definitions on the characterisation of meal patterns will facilitate the interpretation of the existing literature, and may provide guidance on the most appropriate definitions to use.

Snacking behaviors, diet quality, and body mass index in a community sample of working adults

BACKGROUND

Snacking behaviors have been linked with higher energy intake and excess weight. However, results have been inconsistent. In addition, few data are available on the extent to which snacking affects diet quality.

OBJECTIVE

This study describes snacking behaviors, including total snacking energy, frequency, time of day, and percentage of snacking energy intake by food groups, and their associations with diet quality and body mass index (BMI; calculated as kg/m(2)).

DESIGN

Snacking behaviors and dietary intake were examined cross-sectionally among 233 adults participating in a community-based worksite nutrition intervention from September 2010 through February 2013. Three telephone-administered 24-hour dietary recalls were collected (2 weekdays; 1 weekend day). Diet quality was characterized by the Healthy Eating Index 2010 and BMI was computed using measured height and weight.

SETTING

The setting was a large metropolitan medical complex in Minneapolis, Minnesota.

MAIN OUTCOME MEASURES

Outcome measures included diet quality and BMI.

STATISTICAL ANALYSES

General linear regression models were used to examine associations between each of the snacking behaviors as independent variables, and diet quality and BMI as dependent variables.

RESULTS

Percent of snacking energy from fruit and juice (β=.13; P=0.001) and nuts (β=.16; P=0.008) were significantly positively associated with diet quality. Percent of snacking energy from desserts and sweets (β=-.16; P<0.001) and sugar-sweetened beverages (β=-.22; P=0.024) were significantly inversely associated. Percent of snacking energy from vegetables (β=-.18; P=0.044) was significantly associated with lower BMI. Percent snacking energy from desserts and sweets was significantly associated with a higher BMI (β=.04; P=0.017).

CONCLUSIONS

Snack food choices, but not total energy from snacks, frequency, or time of day, were significantly associated with diet quality and BMI.

The Influence of Portion Size and Timing of Meals on Weight Balance and Obesity

This review focuses on the influence of portion size and temporal distribution of food intake on weight balance and obesity in adults. The inconsistency of definitions in the area of meal patterns is also discussed. The conclusion is that regular eating habits might facilitate weight balance, while unplanned snacking as well as consuming the major part of the energy intake at the end of the day seem to be unfavourable. Altogether, the research suggests that large portions promote over-consumption and, therefore, limiting portion size of energy dense foods and drinks with added sugar could be recommended. Even if more research is needed, these factors should be taken into consideration in recommendations for obesity prevention.