Acrylamide in starchy foods subjected to deep-frying, 20 years after its discovery (2002-2022): a patent review

On the occasion of the 20th anniversary of the discovery of acrylamide in food, an analysis of patents related to the mitigation of this compound in food products obtained through immersion frying was carried out. For this purpose, a comprehensive search, compilation, and information analysis were conducted using free online databases such as Google Patents, Patenscope, and Lens. The search yielded a total of 79 patents within the considered time period (2002-2022). The countries with the highest number of granted patents were the United States, the European Union, and South Korea. The patents were classified into four main approaches: raw material modification (49%), application of pre-treatments (27%), process modification (16%), and measurement techniques (8%). Among the results, Frito-Lay, an American company, stands out as the food industry company with the highest number of granted patents, totaling 15. Based on this review, it is concluded that while a significant number of patents have been granted in recent years, there is still a lag in developing countries. Furthermore, more studies are needed to determine acrylamide in starchy food matrices subjected to immersion frying different from potatoes.

Individual and total sugar contents of street foods in Malaysia - Should we be concerned?

Street foods are often of poor nutritional quality with high sugar content, in which the overconsumption of sugar is associated with obesity. However, sugar content information on local street foods is scarce. Thus, the individual and total sugar contents of 94 types of street foods in Malaysia were analysed. Compared to snacks and main meals, desserts contained the highest amounts of sugar, sucrose, fructose, glucose, and maltose. Sucrose was predominant in 90% desserts, 79.3% snacks, and 68.6% main meals. Most desserts (93.3%) contained medium to high sugar content (≥5 g to >15 g/100 g), while 82.9% main meals and 65.5% snacks had low sugar content. When comparing the sugar contents of 39 foods with other local databases, 58.3% main meals, 55.6% desserts, and 33.3% snacks contained either significantly (p < 0.05) higher or lower sugar contents. Consumers can identify low and high-sugar foods, and policymakers can review health priorities to combat obesity.

Achieving high diet quality at eating occasions: findings from a nationally representative study of Australian adults

This study examined differences in food groups consumed at eating occasions by the level of adherence to dietary guidelines in Australian adults (≤19 years) and whether consumption differed with respect to age, sex and education levels. Secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey (n 9054) was performed, using one 24-h dietary recall with self-reported eating occasions. Dietary Guideline Index scores were used to assess adherence to the 2013 Australian Dietary Guidelines. Mean differences (95 % CI) in servings of the five food groups and discretionary foods at eating occasions were estimated for adults with higher and lower diet quality, stratified by sex, age group and education. Using survey-based t-tests, differences of at least half a serving with P values < 0·05 were considered meaningful. Compared with adults with lower diet quality, women and men aged 19-50 years with higher diet quality consumed more serves of vegetables at dinner (mean difference (95 % CI), women; 1·0; 95 % CI (0·7, 1·2); men: 0·9; 95 % CI (0·6, 1·3)) and fewer serves of discretionary foods at snacks (women: -0·7; 95 % CI (-0·9, -0·5); men: -1·0; 95 % CI (-1·4, -0·7). Other food groups, such as grains, dairy products and alternatives, meats and alternatives, were not significantly different between adults with lower and higher diet quality, across any eating occasions and age groups. Discretionary food intake at lunch, dinner and snacks was consistently greater among adults with lower diet quality, regardless of education level. Our findings identify dinner and snacks as opportunities to increase vegetable intake and reduce discretionary food intake, respectively.

Biogenic Salvia species synthesized silver nanoparticles with catalytic, sensing, antimicrobial, and antioxidant properties

Salvia (Lamiaceae family) is used as a brain tonic to improve cognitive function. The species including S. plebeia and S. moorcroftiana are locally used to cure hepatitis, cough, tumours, hemorrhoids, diarrhoea, common cold, flu, and asthma. To the best of authors' knowledge, no previous study has been conducted on synthesis of S. plebeia and S. moorcroftiana silver nanoparticles (SPAgNPs and SMAgNPs). The study was aimed to synthesize AgNPs from the subject species aqueous and ethanol extracts, and assess catalytic potential in degradation of standard and extracted (from yums, candies, and snacks) dyes, nitrophenols, and antibiotics. The study also aimed at AgNPs as probe in sensing metalloids and heavy metal ions including Pb2+, Cu2+, Fe3+, Ni2+, and Zn2+. From the results, it was found that Salvia aqueous extract afforded stable AgNPs in 1:9 and 1:15 (quantity of aqueous extract and silver nitrate solution concentration) whereas ethanol extract yielded AgNPs in 1:10 (quantity of ethanol extract and silver nitrate solution concentration) reacted in sunlight. The size of SPAgNPs and SMAgNPs determined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were 21.7 nm and 19.9 nm, with spherical, cylindrical, and deep hollow morphology. The synthesized AgNPs demonstrated significant potential as catalyst in dyes; Congo red (85 %), methylene blue (75 %), Rhodamine B (<50 %), nitrophenols; ortho-nitrophenol (95-98 %) and para-nitrophenol (95-98 %), dyes extracted from food samples including yums, candies, and snacks. The antibiotics (amoxicillin, doxycycline, levofloxacin) degraded up to 80 %-95 % degradation. Furthermore, the synthesized AgNPs as probe in sensing of Pb2+, Cu2+, and Fe3+ in Kabul river water, due to agglomeration, caused a significant decrease and bathochromic shift of SPR band (430 nm) when analyzed after 30 min. The Pb2+ ions was comparatively more agglomerated and chelated. Thus, the practical applicability of AgNPs in Pb2+ sensing was significant. Based on the results of this research study, the synthesized AgNPs could provide promising efficiency in wastewater treatment containing organic dyes, antibiotics, and heavy metals.

Association between eating habits during adolescence and gestational diabetes: data from the Japan environment and children's study

Purpose

It is difficult to change pre-pregnancy eating habits, yet establishing healthy eating habits before pregnancy is important for preventing gestational diabetes mellitus (GDM). This study aimed to examine whether the weight-loss behavior of avoiding between-meal and midnight snacking in teenagers is associated with a reduction in the risk of subsequent GDM.

Methods

We used a dataset (jecs-an-20,180,131) from a nationwide, prospective birth cohort study, the Japan Environment and Children's Study (JECS). We included 89,227 (85.7% of the total) mother-infant pairs with live births. Participants in their second or third trimester were asked to report their weight-loss behavior during their teenage years. The prevalence of GDM was investigated. Differences in maternal characteristics were examined using chi-square tests. Crude and adjusted logistic regression models were constructed to assess the associations of various maternal characteristics with the weight-loss behavior of avoiding between-meal and midnight snacking during teenage years.

Results

A total of 2,066 (2.3%) participants had GDM. Weight-loss behavior in teenagers was associated with a decreased risk of GDM. Among participants with normal weight or overweight prior to pregnancy, the adjusted odds ratios were 0.79 (95% confidence interval, 0.70-0.89) and 0.82 (95% confidence interval, 0.69-0.98), respectively.

Conclusions

The results suggest that teenage weight-loss behaviors, such as avoiding between-meal and midnight snacking, are associated with a decreased risk of developing GDM.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01294-2.

Junk food consumption and psychological distress in children and adolescents: a systematic review and meta-analysis

Background: Available evidence indicates that junk foods, defined as unhealthy foods with high-calorie and low-nutrient value, negatively affect mental and metabolic health of children. This study aimed to conduct a meta-analysis to clarify the association between junk food consumption and psychological distress in children and adolescents.Methods: A systematic literature search of relevant documents published in PubMed, Web of Science, and SCOPUS was conducted up to 2022. All observation studies which assessed association of junk foods and psychological distress in children and adolescents were included. Random-effect model was used to pool odds ratio (OR) and 95% confidence interval (CI) from individual studies. Subgroup meta-analysis was performed based on junk foods categories (sweet drinks, sweet snacks and snacks).Results: Data of 17 included articles on junk foods consumption in relation to depression, stress, anxiety, sleep dissatisfaction and happiness in children and adolescents were included in this systematic review. According to random effect model, the pooled OR in the highest vs. the lowest category of junk foods was 1.62 (95% CI: 1.35-1.95) for depression, 1.34 (95% CI: 1.16-1.54) for stress, 1.24 (95% CI: 1.03-1.50) for anxiety, 1.17 (95% CI: 1.05-1.30) for sleep dissatisfaction and 0.83 (95% CI: 0.75-0.92) for happiness. In subgroup meta-analysis, there were significant associations between different types of junk foods and psychological distress (P < 0.05).Conclusion: This meta-analysis showed that junk foods consumption was associated with increased odds of psychological distress in children and adolescents. These findings support the current recommendation of decreasing junk foods intake.

Motivational Interviewing in Pediatric Obesity: A Meta-analysis of the Effects on Behavioral Outcomes

BACKGROUND

Currently, the effects of motivational interviewing (MI) on children's behavioral changes remain obscure.

PURPOSE

This systematic review and meta-analysis examined the effects of MI on children's lifestyle behavioral changes (fruits and vegetables [F/V], dairy, sugary beverages, calories, snacks, fat intake, moderate vigorous physical activity [MVPA], and screen time).

METHODS

Six databases (CINAHL, Cochrane, Embase, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2022 were searched. Thirty-one intervention studies with a comparison group met the criteria. Random-effects models were performed to estimate the pooled effects; exploratory moderation analyses with mixed-effects models were used to explore potential intervention moderators.

RESULTS

The pooled effect size was 0.10 (p = .334) on ↑F/V, 0.02 (p = .724) on ↑dairy, -0.29 (p < .001) on ↓calories, -0.16 (p = .054) on ↓sugary beverages, -0.22 (p = .002) on ↓snacks, -0.20 (p = .044) on ↓fat, 0.22 (p = .001) on ↑MVPA, and -0.06 (p = .176) on ↓screen time. The effects of MIs were moderated by ↑MI sessions regarding ↓snacks (B = -0.04, p = .010). Multicomponent and clinical programs had greater effects on dairy intake than their counterparts (0.09 vs. -0.21, p = .034; 0.12 vs. -0.14, p = .027, respectively). Similarly, interventions with a fidelity check resulted in greater dairy intake than those without a check (0.29 vs. -0.15, p = .014). A few long-term follow-up assessments revealed effects on ↓F/V (-0.18; p = .143, k = 2), ↓dairy (-0.13, p = .399, k = 4), ↓MVPA (-0.04; p = .611, k = 6), and ↑screen time (0.12; p = .242, k = 4).

CONCLUSIONS

Our findings support the short-term effects of MI on improving children's lifestyle behaviors. Additional investigations are needed to better sustain children's long-term behavioral changes.

Effect of a relative pricing intervention and active merchandising on snack purchases: interrupted time series analysis of a hospital retailer-led strategy

BACKGROUND

Pricing policies have been shown to be an effective lever for promoting healthier dietary choices in consumer food environments. It is not yet well understood how pricing can be used to encourage healthier substitute purchases. The aim of the study was to assess the effect of a retailer-led relative pricing intervention on weekly purchases of targeted snack foods and beverages.

METHODS

This was an ecological analysis in a real-world large tertiary hospital consumer food environment setting in urban Canada, comprised of four retail outlets: two large cafeterias, one smaller cafeteria, and one grab-and-go café. An interrupted time series analysis was designed to evaluate the effect of Snacking Made Simple, a retailer-led relative pricing intervention applied to 10 popular snack foods and beverages (n = 87 weeks, 66 weeks baseline and 21 weeks intervention, April 2018 to December 2019), on weekly purchase differences between healthier and less healthy targeted items, adjusted for weekly sales volume. Five healthier items were price discounted, alongside a price increase for five less healthy items. The intervention was actively merchandised in keeping with behaviour change theory.

RESULTS

Weekly purchases of targeted snacks became healthier during the intervention period (β = 21.41, p = 0.0024). This followed a baseline period during which weekly purchases of less healthy targeted snacks had outpaced over time those of healthier targeted snacks (β = -11.02, p = 3.68E-14). We estimated that, all else being equal, a hypothetical 9.43 additional weeks of the intervention would be required to transition to net-healthier targeted snack purchases in this environment. The effects of the intervention varied by retail outlet, and the outcome appears driven by specific food items; further, examining merchandising implementation, we posited whether direct versus indirect substitution may have affected purchasing outcomes.

CONCLUSIONS

Relative pricing may be a promising way to incentivize healthier substitute purchasing in the consumer food environment. Added attention to merchandising strategy as well as value-add factors within food categories and their effects on price salience may be an important factor in effective intervention design.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Association of Snacking Frequency, Size, and Energy Density with Weight Status among Preschool-Aged Children in the United States

BACKGROUND

Snacking (ie, eating between meals) is common among US preschool-aged children, but associations with weight status are unclear.

OBJECTIVE

This research evaluated associations of snack frequency, size, and energy density as well as the percent of daily energy from snacking with weight status and sociodemographic characteristics among US children aged 2 to 5 years.

DESIGN

Cross-sectional analysis of 2007-2018 National Health and Nutrition Examination Survey data using two, caregiver proxy, 24-hour dietary recalls.

PARTICIPANTS/SETTING

US children aged 2 to 5 years (n = 3,313) with at least one snack occasion over 2 days of intake.

MAIN OUTCOME MEASURES

Snacking parameters included frequency (number of occasions per day), size (kilocalories per occasion), and energy density (kilocalories per gram per occasion) as well as percent of daily energy from snacking.

STATISTICAL ANALYSES

Generalized linear regression models evaluated associations of snacking with child weight status (ie, normal weight and overweight/obesity), adjusting for survey weights, energy misreporting, mean meal size, and sociodemographic covariates.

RESULTS

Children with overweight/obesity consumed more frequent snacks (2.8 [0.06] vs 2.5 [0.03] snacks/day, respectively; P < 0.001), larger snacks (188 [4] vs 162 [23] kcal/occasion, respectively; P < 0.001), and a greater percent of daily energy from snacking (29.80% [1.00%] vs 26.09% [0.40%], respectively; P < 0.001) than children with normal weight. Mean snack frequency and size as well as percentage of daily energy from snacking varied with child age, gender, and head of household education. Associations of snacking with child race and ethnicity were less consistent.

CONCLUSIONS

These nationally representative findings provide evidence that the consumption of larger, more frequent snacks is associated with overweight/obesity among US children aged 2 to 5 years and snacking varies by sociodemographic characteristics.

Eating patterns in a nationwide sample of Japanese aged 1-79 years from MINNADE study: eating frequency, clock time for eating, time spent on eating and variability of eating patterns

OBJECTIVE

Although there is growing evidence suggesting that eating patterns are important determinants of health status, comprehensive information on patterning of eating behaviours is almost lacking. The aim of this cross-sectional study was to describe eating patterns in Japan.

DESIGN

Information on actual eating behaviours was collected using 2-d dietary record in each season over a year (total 8 d). Eating occasions were defined as any discrete intake occasion (with a discrete start clock time and name) except for eating occasions consisting of water only, which were excluded.

SETTING

Japan.

PARTICIPANTS

A nationwide sample of 4032 Japanese aged 1-79 years.

RESULTS

The mean value of eating frequency of meals (i.e. breakfast, lunch and dinner), snacks and total eating occasions was 2·94, 1·74 and 4·68 times/d, respectively. The mean clock time for the start of breakfast, lunch and dinner was 07.24, 12.29 and 19.15 h, respectively. The mean time spent consuming breakfast, lunch, dinner and snacks was 19, 25, 34 and 27 min/d, respectively. On average, variability (i.e. average of absolute difference from mean) of meal frequency was small compared with that of snack frequency and total eating frequency. Both mean variability of clock time for the start of eating (<1 h) and mean variability of time spent on meals (<10 min/d) were also small. Conversely, mean variability of time spent on snacks was large (>18 min/d).

CONCLUSION

The present findings serve as both a reference and an indication for future research on patterning of eating behaviours.

The Content and Toxicological Risk Assessment of Trace Elemental Impurities (Pb and Cr) in Snacks from Ogun State, Southwestern Nigeria

The monitoring of food contamination by trace elemental impurities (TEIs) are major health challenges in developing countries. The present study evaluated the content and toxicological risk assessment of TEIs in commonly consumed snack/junk foods from Ogun State, Nigeria. TEIs (Pb and Cr) were determined in sixty snack food samples purchased from Ijebu Ode, Ogun State, southwestern Nigeria. The TEIs were analysed in quadruplicates using atomic absorption spectrometry with flame atomization. TEI data were subjected to simple descriptive and inferential statistics. The toxicological risk assessment of TEIs was evaluated for hazard quotient (HQ), hazard index (HI) and cancer risk (CR) using the United States Environmental Protection Agency-Integrated Risk Information System (USEPA-IRIS) model. Data showed the varying Pb levels of 8.22 ± 1.57 mg/kg in sausage to 12.25 ± 4.27 mg/kg in cocoyam chips higher than the permissible limit of the Codex Alimentarius of the Joint World Health Organization and Food and Agriculture Organization. The toxicological risk assessment revealed the HQs greater than 1.0 for Pb and Cr in most snack foods consumed by adults and children, indicating adverse health problems. The CRs of Pb (children) and Cr (adults and children) also breached the acceptable limit of 1.0 × 10^-4, signifying possible lifetime development of cancer. It is therefore necessary to periodically monitor the TEIs in snacks to protect the public health.

The Toxicological Risk Assessment of Trace Elements (Co, Cu, Fe, and Zn) in Snacks from Ijebu Ode, Ogun State, Southwest, Nigeria

Snacks or junk foods are a form of relatively small, packaged, ready-to-eat fast foods, usually taken not as a regular, but as a stopgap. However, contamination of snacks with trace elemental impurities may pose serious health risk to consumers. The main objective of the present study is to assess the toxicological risk of trace elements TEs (Co, Cu, Fe, and Zn) in commonly consumed snack/junk foods from Ijebu Ode, Ogun State, Southwest, Nigeria. A total of sixty snack food samples were purchased and assayed in replicates for Co, Cu, Fe, and Zn using atomic absorption spectrophotometer. Trace elements data were manipulated for simple descriptive and inferential statistics. The toxicological risk of metals was estimated for average daily dose (ADD), hazard quotient (HQ), hazard index (HI), and cancer risk (CR). Results showed Fe as the most abundant TE in the snacks showing insignificant mean concentrations (p > 0.05) varying from 38.10 ± 1.98 mg kg^-1 (potato chip) to 71.25 ± 14.68 mg kg^-1 (cashew nut). Cashew nut had the highest amounts of the TEs. The HQs of Co in all the snacks except corn flakes consumed by children were greater than the threshold limit of 1.0, indicating non-carcinogenic adverse effects. The CRs of Co in all the food samples exceeded the acceptable limit of 1.0 × 10^-4, suggesting possible development of cancer by the consumers. Co is a trace metal of health issues in the snack/junk foods. This study therefore recommends periodic monitoring and toxicological assessment of metals in snacks, especially the raw materials and processing feedstocks.

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus-beyond dietary patterns: a narrative review

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

Eating habits are associated with subjective sleep quality outcomes among university students: findings of a cross-sectional study

PURPOSE

This study investigated the relationships between eating habits and sleep quality among university students.

METHODS

In a cross-sectional study, university students completed a self-report questionnaire to assess eating habits and meal timing. We assessed subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and examined the associations between eating habits and overall sleep quality and its components.

RESULTS

Four hundred ninety-eight students participated in the study. Students who used to skip breakfast, ate late-night snacks, and replaced meals with snacks were at 1.20 times, 1.24 times, and 1.25 times higher likelihood of having poor overall sleep quality, respectively. Multiple logistic regression analysis showed that skipping breakfast (r =  - 0.111, P = 0.007), late-night snacks (r =  - 0.109, P = 0.007), replacing meals with snacks (r =  - 0.126, P = 0.002), and irregular mealtimes (r =  - 0.094, P = 0.018) were the best correlates with poor sleep quality. After adjustment to demographic variables, replacing meals with snacks followed by skipping breakfast were the best independent associations with poor sleep quality by the PSQI.

CONCLUSIONS

Eating habits and meal timing were significantly associated with sleep quality. We speculate that healthy eating habits may lead to improved sleep quality and sleep components among university students.

Outcome evaluation of fruits and vegetables distribution interventions in schools: a systematic review and meta-analysis

OBJECTIVE

Fruits and vegetables (FV) distribution interventions have been implemented as a public health strategy to increase children's intake of FV at school settings. The purpose of this review was to examine whether snack-based FV distribution interventions can improve school-aged children's consumption of FV.

DESIGN

Systematic review and meta-analysis of articles published in English, in a peer-reviewed journals, were identified by searching six databases up to August 2020. Standardised mean differences (SMD) and 95 % CI were calculated using a random effects model. Heterogeneity was quantified using I2 statistics.

SETTING

Population-based studies of interventions where the main focus was the effectiveness of distributed FV as snacks to schoolchildren in North America, Europe and Pacific were included.

RESULTS

Forty-seven studies, reporting on fifteen different interventions, were identified; ten studies were included in the meta-analysis. All interventions were effective in increasing children's consumption of FV, with only one intervention demonstrating a null effect. Pooled results under all classifications showed effectiveness in improving children's consumption of FV, particularly for multi-component interventions at post-intervention (SMD 0·20, 95 % CI 0·13, 0·27) and free distribution interventions at follow-up (SMD 0·19, 95 % CI 0·12, 0·27).

CONCLUSIONS

Findings suggest that FV distribution interventions provide a promising avenue by which children's consumption can be improved. Nonetheless, our results are based on a limited number of studies, and further studies should be performed to confirm these results. More consistent measurement protocols in terms of rigorous study methodologies, intervention duration and follow-up evaluation are needed to improve comparability across studies.

Using food network analysis to understand meal patterns in pregnant women with high and low diet quality

BACKGROUND

Little is known about how meal-specific food intake contributes to overall diet quality during pregnancy, which is related to numerous maternal and child health outcomes. Food networks are probabilistic graphs using partial correlations to identify relationships among food groups in dietary intake data, and can be analyzed at the meal level. This study investigated food networks across meals in pregnant women and explored differences by overall diet quality classification.

METHODS

Women were asked to complete three 24-h dietary recalls throughout pregnancy (n = 365) within a prospective cohort study in the US. Pregnancy diet quality was evaluated using the Healthy Eating Index-2015 (HEI, range 0-100), calculated across pregnancy. Networks from 40 food groups were derived for women in the highest and lowest HEI tertiles at each participant-labeled meal (i.e., breakfast, lunch, dinner, snacks) using Gaussian graphical models. Network composition was qualitatively compared across meals and between HEI tertiles.

RESULTS

In both HEI tertiles, breakfast food combinations comprised ready-to-eat cereals with milk, quick breads with sweets (e.g., pancakes with syrup), and bread with cheese and meat. Vegetables were consumed at breakfast among women in the high HEI tertile only. Combinations at lunch and dinner were more varied, including vegetables with oils (e.g., salads) in the high tertile and sugary foods with nuts, fruits, and milk in the low tertile at lunch; and cooked grains with fats (e.g., pasta with oil) in the high tertile and potatoes with vegetables and meat in the low tertile at dinner. Fried potatoes, sugar-sweetened beverages, and sandwiches were consumed together at all main meals in the low tertile only. Foods were consumed individually at snacks in both tertiles; the most commonly consumed food were fruits in the high HEI tertile and cakes & cookies in the low tertile.

CONCLUSIONS

In this cohort of pregnant women, food network analysis indicated that food combinations differed by meal and between HEI tertiles. Meal-specific patterns that differed between diet quality tertiles suggest potential targets to improve food choices at meals; the impact of meal-based dietary modifications on intake of correlated foods and on overall diet quality should be investigated in simulations and intervention studies.

TRIAL REGISTRATION

PEAS was registered with number NCT02217462 in Clinicaltrials.gov on August 13, 2014.

Helping parents provide vegetable snacks: Investigating price and taste as barriers

Snacks contribute nearly one-quarter of children's daily energy intake in the USA. Snack time therefore represents an opportunity for parents to provide foods with key nutrients. Instead, the most common snack foods are major contributors to children's consumption of added sugars and sodium. Parents face major barriers to providing healthier snacks, including perceptions of high cost and lack of child acceptance. We obtained both economic and qualitative data to inform and optimize interventions for parents to promote vegetable snacks for children. We conducted a survey with parents (n = 368) to estimate how much of a discount would influence vegetable snack purchases by estimating willingness-to-pay using the contingent valuation method, using baby-cut carrots as a sample product. We conducted three focus groups (n = 19) and 1 group interview (n = 2) with children to help understand how to increase the appeal of vegetable snacks. Most (70%) parents accepted the reference price for the vegetable snack. Among those who did not, contingent valuation analysis revealed that a mean discount of approximately 30% would shift consumers to purchasing the snack. Focus group results revealed that the appeal of vegetable snacks to children was influenced by how they were prepared and presented, and the child's familiarity with the vegetables and ability to choose among them. This study lays the groundwork for effective interventions to promote the provision of vegetable snacks by parents.

A recurrent cross-sectional qualitative study exploring how low-income mothers define snacks and reasons for offering snacks during infancy

Despite rapid increases in snacking in recent decades, little is known about snacking during infancy. This study explored how low-income mothers define snacks and their reasons for offering snacks during infancy. A recurrent cross-sectional qualitative approach was used to identify themes from semi-structured interviews with low-income mothers when their infants were 6 and 12 months of age. A purposive sample of mothers (N = 15) was recruited from Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offices and childcare centers serving low-income families in Rhode Island. Mothers also completed demographic and infant feeding questionnaires. Independent thematic analyses were conducted to identify themes from the 6 and 12 month interviews. Themes from the 6 month interviews for how mothers defined snacks were: snacks are consumed between meals, snacks are smaller portions, and snacks are sweet. Themes from the 12 month interviews also included snacks are consumed between meals and snacks are smaller portions with one additional theme: snacks do not include all food groups. Themes from the 6 month interviews for the reasons mothers offered snacks were: infants seemed hungry, infants showed interest, and snacks help manage behavior. Themes from 12 month interviews also included snacks help manage behavior with two additional themes: snacks expose infants to different flavors and snacks expose infants to different textures. Findings suggest that snacks are commonly offered during infancy and that mothers define snacks as smaller portions that help with hunger between meals. However, during early infancy mothers describe snacks as sweet, and across infancy report using snacks to manage behavior, underscoring the importance of providing parents with guidance on healthy snacking during the first year of life.

Development of novel functional snacks containing nano-encapsulated resveratrol with anti-diabetic, anti-obesity and antioxidant properties

In this study, functional snacks with addition of nanoenapsuated resveratrol were prepared to evaluate the nutraceutical and physical properties. The nanoencapsulated resveratrol was prepared from horse-chestnut (HRP), water-chestnut (WRP) and lotus-stem starch particles (LRP) and added to the wheat flour at the level of 0.4% for preparation of snacks by extrusing process. After extrusion, 43-53% and 5.42% of resveratrol was retained in snacks containing encapsulated and free resveratrol (FRP), respectively. The HRP, WRP and LRP showed significantly less peak viscosities and less elastic behaviour than native product (NP) which can influence the human sensory perception. The shift of few peaks towards higher wavelength and presence of additional peaks at 1384, 1229, 1513 and 1613 cm^-1 depicts change in molecular pattern and presence of resveratrol in functional snacks. The functional snacks containing encapsulated resveratrol showed significantly higher antioxidant, anti-diabetic and anti-obesity properties than snacks containing no or free resveratrol.

Smart snacks in universities: possibilities for university vending

Background: The study goal was to evaluate the nutritional impact of a healthy snack intervention on a southern university campus.

Methods: This quasi-experimental study was conducted during the fall 2017 semester weekly for 14 weeks in a large southern U.S. university. For the intervention, half of vending snacks in four campus residential halls (housing from 216 to 361 students) were substituted with snacks complying with federal Smart Snacks in School nutrition standards for K-12 schools. For analysis, data from the Nutrition Facts labels of 14 vending machines or from manufacturer’s websites was collected by trained graduate and undergraduate researchers.

Results: On average, for each Smart Snack sold, there was a statistically significant reduction of 99.38 calories (CI=42.32, 156.43), 4 g saturated fat (CI = 2.23, 5.75), and 10.06 g of sugar(CI=2.92, 17.20). An average reduction of 41.88 mg in sodium and an increase of 0.81g in fiber was also found, but was not statistically significant. There was a significant difference (t(16)=3.02, P < 0.025, 95% CI = 10.77, 55.79) between the Quality Score of Smart Snacks (M=59.13,SD= ± 36.50) and that of non-compliant snacks (M=25.85, SD= ± 24.72).

Conclusion: The nutritional impact with even a 50% Smart Snack replacement is promising. Many available comparable snacks mimic the mouthfeel, taste, and appearance of their original full-fat, full-sodium, and full-sugar counterparts. Including healthier snack choices in vending machines may be a viable option for universities to transform the campus eating environment.

Process evaluation of fruit and vegetables distribution interventions in school-based settings: A systematic review

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Assesses how school fruit & vegetable distribution interventions are implemented.

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Child fruit & vegetable intake is influenced by how intervention is implemented.

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Recommendations for implementing fruit & vegetable interventions in schools.

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Studies should also consider sustainability, cost-effectiveness and implementation.

Despite the importance of process evaluation in program evaluations, research has focused primarily on the effectiveness of fruit and vegetables (FVs) distribution interventions on children’s consumption, with little attention given to how these interventions achieve their outcomes. Five bibliographic databases (Embase, PubMed, ProQuest, Scopus, and Web of Science Core Collection) were searched in June 2019 for studies of interventions where the main focus was the implementation of distributed FVs to school-aged children as a snack. The Critical Appraisal Skills Programme (CASP) tool was used to appraise the risk of bias within included studies. Data were extracted based on study characteristics and findings. Results identified 24 studies reporting on 11 interventions and 1 policy. The findings of this systematic review indicate that the majority of the studies included limited references to implementation research. Recurring limitations include an absence of an evaluation theoretical framework and the data collection methods used. Also, several factors were identified as informing the success of snack-based FVs distribution programs, including participation of the school community, school characteristics, background knowledge, and parental engagement. Lack of timely FVs delivery, limited funding, inadequate awareness about the program, insufficient teachers’ time, and food waste were identified as challenges to successful programming. Findings indicate that distributing FVs to school-aged children as a snack can increase their consumption, but only with proper implementation. Further evaluative research is required to better inform future implementation of snack-based FV distribution interventions in school settings.

Feeding practices demonstrated by parents of toddlers: An observational analysis of breakfast, lunch, dinner, and snacks

The aims of the current study were to compare feeding practices and the eating environment (other people present, other people eating, and screen use) observed in families of toddlers across breakfast, lunch, dinner, and snacks. 60 families with toddlers (12-36 months; M = 24.7 months) video recorded all occasions over the course of a day when the toddler ate or drank. Videos were coded for a variety of feeding practices (e.g., prompts to eat, restriction), other people present and eating, and screen use. Prompts to eat were grouped into autonomy-supportive prompts (ASP) and coercive-controlling prompts (CCP). Results of the study showed different patterns of consistency between meals and snacks depending on the feeding practice examined. CCP were correlated across all eating occasions, including meals and snacks, but ASP, interference, and instruction were only correlated across the primary meals (all p-values < .05). ASP and praise were also more frequently demonstrated during the primary meals compared to snacks (p-values < .05). Parents also used more interference at dinner compared to both breakfast and snacks. Furthermore, mothers and siblings commonly ate with the toddler, especially during lunch and dinner, but family members infrequently ate with the child during snacks. The percentage of families using a screen was similar for breakfast (38%), lunch (39%), and dinner (33%), but slightly higher for snacks (47%). Together, the results of this study demonstrate notable differences in feeding practices and environmental factors during meals compared to snacks.

Understanding the influence of physical resources and social supports on primary food providers' snack food provision: a discrete choice experiment

BACKGROUND

Snack eating occasions contribute approximately a third of children's energy intake, with approximately half of all unhealthy foods consumed during snack times. Therefore, it is critical to understand the drivers of primary food providers' snack provision. The study aims were to determine the relative importance of physical resources and social supports when primary food providers are choosing snacks to provide to their child, and to investigate how these attributes differ in social versus non-social occasions, and between subgroups of primary food providers based on socio-economic position.

METHODS

Primary food providers of three to seven-year olds completed an online discrete choice experiment, by making trade-offs when completing repeated, hypothetical choice tasks on the choice of snacks to provide to their child in: 1) non-social and 2) social condition. Choice tasks included two alternatives consisting of varying attribute (i.e. factor) levels, and an opt-out option. The order of conditions shown were randomized across participants. Multinomial logit model analyses were used to determine utility weights for each attribute.

RESULTS

Two-hundred and twenty-five primary food providers completed the study, providing 1125 choice decisions per condition. In the non-social condition, the top three ranked attributes were type of food (utility weight 1.94, p < 0.001), child resistance (- 1.62, p < 0.001) and co-parent support (0.99, p < 0.001). In the social condition, top ranking attributes were child resistance (utility weight - 1.50, p < 0.001), type of food (1.38, p < 0.001) and co-parent support (1.07, p < 0.001). In both conditions, time was not a significant influence and cost was of lowest relative importance. Subgroup analyses revealed cost was not a significant influence for families from higher socio-economic backgrounds.

CONCLUSIONS

Type of food, child resistance and co-parent support were of greatest relative importance in primary food providers' snack provision decision-making, regardless of social condition or socio-economic position. In designing future interventions to reduce unhealthy snacks, researchers should prioritize these influences, to better support primary food providers in changing their physical and social opportunity.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry no. ACTR N12618001173280.

Impact of health warning labels on snack selection: An online experimental study

Excessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. In a between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design, participants (N = 4134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task. The proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (no label: 59%; calories only: 54%; text-only HWL: 48%; text-only HWL with calories: 44%; image-and-text HWL: 37%; image-and-text HWL with calories: 38%). Compared to the no label group, participants were least likely to select an energy-dense snack in the image-and-text HWL group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001). Health warning labels - particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.

Meal and snack patterns of 7-13-year-old schoolchildren in southern Brazil

OBJECTIVE

The aim of the current study was to identify and describe the meal and snack patterns (breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner and evening snack) of public schoolchildren.

DESIGN

Cross-sectional study. Information on the previous day's food intake was obtained through the Web-CAAFE (Food Intake and Physical Activity of Schoolchildren), an interactive questionnaire, which divides daily food consumption into three meals (breakfast, lunch and dinner) and three snacks (mid-morning, mid-afternoon and evening). Each meal contains thirty-one food items and the schoolchildren clicked on the food items consumed in each meal. Factor analysis was used to identify meal and snack patterns. The descriptions of the dietary patterns (DP) were based on food items with factor loads ≥ 0·30 that were considered representative of each DP.

SETTING

Schoolchildren, Florianopolis, Brazil.

PARTICIPANTS

Children (n 1074) aged 7-13 years.

RESULTS

Lunch was the most consumed meal (96·0 %), followed by dinner (86·4 %), breakfast (85·3 %) and mid-afternoon snack (81·7 %). Four DP were identified for breakfast, mid-morning snack, lunch, dinner and evening snack, and three for mid-afternoon snack. Breakfast, lunch and dinner patterns included traditional Brazilian foods. DP consisting of fast foods and sugary beverages were also observed, mainly for the evening snack.

CONCLUSIONS

The results of the current study provide important information regarding the meal and snack patterns of schoolchildren to guide the development of nutrition interventions in public health.

Food group intake at self-reported eating occasions across the day: secondary analysis of the Australian National Nutrition Survey 2011-2012

OBJECTIVE

To examine core and discretionary food and beverage intake at eating occasions, and to explore the variation in consumption by age and gender in Australian adults and children.

DESIGN

The study utilised one 24-h dietary recall with self-reported eating occasions from a nationally representative sample of Australians. Average servings of each food group for age and gender subpopulations were compared with the Australian Dietary Guidelines. The percentage contribution of each eating occasion to total daily food group intake and typical composition of eating occasions were described. Frequently consumed discretionary foods were reported for eating occasions by age and gender.

SETTING

2011-2012 Australian National Nutrition and Physical Activity Survey.

PARTICIPANTS

12 153 Australian people aged 2 years and above.

RESULTS

Grains were consumed in equal proportions throughout the day across all age and gender subgroups, while remaining core food groups were unequally distributed, featuring more prominently at specific eating occasions. Children consumed two-thirds of their fruit intake as snacks, and up to three quarters of adults' vegetable and meat intake was consumed at dinner. Children consumed more of their discretionary intake at mid-meals, while adults consumed a greater proportion as part of a main meal.

CONCLUSIONS

The present study provides a detailed understanding about when food groups are consumed, the 'typical' meal composition across the day, and how consumption patterns and compliance with dietary guidelines differ by age group and gender. These findings can assist in developing more specific nutrition messages which may help to achieve greater improvements in population dietary intake.

Meal and snack frequency in relation to diet quality in Japanese adults: a cross-sectional study using different definitions of meals and snacks

Epidemiological evidence on the association between eating frequency and overall diet quality does not represent a consistent picture. This cross-sectional study examined the associations of meal frequency and snack frequency with diet quality, using different definitions of meals and snacks. Based on 4-d weighed dietary record data obtained from 639 Japanese adults aged 20-81 years, all eating occasions were divided into meals or snacks based on either the participant-identified or time-of-day definitions. Diet quality was assessed by the Healthy Eating Index-2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). One additional meal per d increased the HEI-2015 total score by 3·6 and 1·3 points based on the participant-identified and time-of-day definitions, respectively. A higher meal frequency was also associated with higher values of some of the HEI-2015 component scores (total vegetables, greens and beans, and total protein foods), irrespective of how meals were defined. Additionally, one additional participant-identified snack per d increased the HEI-2015 total score by 0·7 points. The frequency of participant-identified snacks also showed positive associations with some of the HEI-2015 component scores (total fruits, whole fruits, total vegetables, greens and beans, dairy products, and Na). However, the frequency of time-of-day defined snacks was not associated with the total scores of HEI-2015, although there were some associations for its components. Similar findings were obtained when the NRF9.3 was used. In conclusion, higher meal frequency was consistently associated with higher diet quality, while associations between snack frequency and diet quality varied depending on the definition of snacks.

Can unhealthy food purchases at checkout counters be discouraged by introducing healthier snacks? A real-life experiment in supermarkets in deprived urban areas in the Netherlands

BACKGROUND

The checkout area in supermarkets is an unavoidable point of purchase where impulsive food purchases are likely to be made. However, the product assortment at the checkout counters is predominantly unhealthy. The aim of this real life experiment was to investigate if unhealthy food purchases at checkout counters in supermarkets in deprived urban areas in the Netherlands can be discouraged by the introduction of the Healthy Checkout Counter (HCC). In addition, we examined customers' perceptions towards the HCC.

METHODS

The HCC was an initiative of a leading supermarket chain in the Netherlands that consisted of displays with a selection of healthier snacks that were placed at the checkouts. We used a real life quasi-experimental design with 15 intervention and 9 control supermarkets. We also performed a cross-sectional customer evaluation in 3 intervention  supermarkets using oral surveys to investigate customers' perceptions towards the HCC (n=134). The purchases of unhealthy and healthier snacks at checkouts were measured with sales data.

RESULTS

During the intervention period, customers purchased on average 1.7 (SD: 0.08) unhealthy snacks per 100 customers in the intervention supermarket and 1.4 (SD: 0.10) in the control supermarket. Linear regression analyses revealed no statistically significant difference in the change during the control and intervention period of sales of unhealthy snacks between the control and intervention supermarkets (B = - 0.008, 95% CI = - 0.15 to 0.14). The average number of healthier snacks purchased was 0.2 (SD: 0.3) items per 100 customers in the intervention supermarkets during the intervention period. Of the intervention customers, 41% noticed the HCC and 80% of them were satisfied or very satisfied with the intervention.

CONCLUSIONS

This real life experiment in supermarkets showed that the placement of healthier snacks at checkouts did not lead to the substitution of unhealthy snack purchases with healthier alternatives. Although supermarket customers positively evaluated the HCC, future studies are needed to investigate other strategies to encourage healthier food purchases in supermarkets.

Monitoring of pyrrolizidine alkaloids in beehive products and derivatives on the Belgian market

Pyrrolizidine alkaloids (PAs) and related N-oxides (PANOs) are secondary plant metabolites thought to be found in approximately 3% of the flowering plants worldwide and exhibiting hepatotoxic properties to humans. As a consequence, beehive products are prone to be contaminated with those compounds by bees foraging PA-producing plants. Downstream contamination can also occur through food items containing honey. Analytical methods based on UHPLC separation and MS/MS detection were developed with a focus on very low LOQs and validated for the analysis of 16 PAs and 14 PANOs in honey, honey-based candies and snacks, as well as beehive product-based food supplements. A maximum level of 182 ng/g of PAs was detected in a Mediterranean honey, and high levels of heliotrine-type compounds were reported for the first time. An extensive sampling of honeys harvested in Belgium was performed (N = 374), the concentration levels were more limited with a maximum of 60 ng/g, and the contamination pattern was dominated by senecionine-type PAs. The PA levels in honey-based candies and snacks were very low, with respective maxima of 7.61 ng/g and 0.36 ng/g. Seventy-five percent among the pre-dosed food supplements based on beehive products were contaminated, with a maximum of 43 ng/g. The highest level was detected in a bee-collected pollen sample (1672 ng/g). The analytical results were consistent with the previously reported data for beehive products and confirmed that PA/PANO contamination in these food commodities is recurrent.

Optimism is associated with diet quality, food group consumption and snacking behavior in a general population

BACKGROUND

Dispositional optimism is a psychological trait that has been associated with positive health outcomes such as reduced risk of cardiovascular diseases. However, there is little knowledge on the relationship between optimism and dietary intake in the population. The objective of this cross-sectional study was to assess whether optimism was associated with overall diet quality, food group consumption and snacking.

METHODS

In 2016, 32,806 adult participants from the NutriNet-Santé study completed the Life-Orientation Test Revised (LOT-R) which assesses dispositional optimism. Overall diet quality (assessed by the mPNNS-Guideline Score) and consumption of 22 food groups were evaluated using at least three self-reported 24-h dietary records. Snacking behavior was evaluated by an ad-hoc question. Logistic and linear regressions were used to analyze the associations between optimism and these dietary behaviors, taking into account socio-demographic, lifestyle and depressive symptomatology characteristics.

RESULTS

Optimism was associated with greater overall diet quality (β (95% CI) = 0.07 (0.004-0.11), P < 0.0001) and higher consumption of fruit and vegetables, seafood, whole grains, fats, dairy and meat substitutes, legumes, non-salted oleaginous fruits, and negatively associated with consumption of meat and poultry, dairy products, milk-based desserts, sugar and confectionery. In addition, optimism was associated with less snacking (OR (95% CI) = 0.89 (0.84, 0.95)). In contrast, optimism was associated with higher consumption of alcoholic beverage (β (95% CI) = 5.71 (2.54-8.88), P = 0.0004) and appetizers (OR (95% CI) = 1.09 (1.04, 1.14)). Finally, no association was observed between optimism and energy intake.

CONCLUSIONS

Optimism was associated with better overall diet quality and less snacking. It was also associated with consumption of healthy food groups as well as unhealthy food groups typically consumed in social eating occasions. These findings suggest that optimism could be taken into account in the promotion of a healthy eating behavior.

Production of innovative gluten-free breakfast cereals based on red and black rice by extrusion processing technology

The transformation of black and red, broken or not, whole rice grains, into breakfast cereals is an interesting way to add value to these snacks for some reasons. Firstly, broken kernels hardly achieve a high market value; whole rice is healthy not only for their nutrient contents but also for their phytochemical profile, rich in phenolic compounds; breakfast cereals from pigmented rice are colored by themselves, and any additional colorant is unneeded; finally, rice is naturally gluten-free and suitable for those with conditions like celiac disease or gluten sensitivity. The objective of this study was to optimize some extrusion parameters that account for the physicochemical properties of extrudates by using response surface methodology. Feed moisture between 15 and 21% and the 4th barrel zone temperature between 110 and 160 °C were the independent variables. Specific features such as color, texture, water solubility and absorption, cold viscosity, expansion, specific volume, and compression force were evaluated. The trials have shown that moisture had a higher impact on the extrusion process than temperature. Less expanded, denser, harder, and darker products were obtained at higher moisture levels. The optimum points were defined at 15.5% and 16.0% of feed moisture and 159 °C and 150 °C of temperature for black and red rice extrudates, respectively. These conditions resulted in cereal breakfast balls with optimal water solubility, volume, texture, and good color. Additionally, cold viscosities and a low compression led to products with a potential high approval by consumers.

Elevated serum levels of aminotransferases in relation to unhealthy foods intake: Tehran lipid and glucose study

BACKGROUND

Abnormal levels of liver enzymes, particularly aminotransferases, are prognostic features of non-alcoholic fatty liver disease (NAFLD). Considering the important role of dietary intakes in development of NAFLD, we aimed to determine possible association of unhealthy foods (fast foods, soft drinks, sweet and salty snacks) consumption with elevated levels of aminotransferases.

METHODS

This cross-sectional study was conducted within the framework of sixth phase of the Tehran Lipid and Glucose Study (2014-2017), on 187 adult men and 249 adult women (19-70 y). Usual intakes of unhealthy foods (kcal/week) were measured using a validated semi-quantitative 147-items food frequency questionnaire. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) were measured. Multivariable logistic regression models were used to estimate the odds of elevated aminotransferases in each tertile of energy-dense unhealthy foods.

RESULTS

Mean age of participants was 44.44 ± 15.09 years, 43% of participants were men. Higher consumption of fast foods (> 11.39% kcal/week) was associated with elevated ALT to AST ratio (OR: 3.27; 95% CI: 1.90-5.63) and elevated ALT (OR: 2.74; 95% CI: 1.57-4.76). Also, each 1 SD increased energy intakes from fast foods was related to increased chance of having elevated ALT and ALT to AST ratio by 35% (OR: 1.35; 95% CI: 1.08-1.68, OR: 1.35; 95% CI: 1.10-1.66, respectively). There was no significant association between consumption of soft drinks, sweet or salty snacks and elevated aminotransferases.

CONCLUSIONS

Higher intakes of energy from fast foods seems to be associated with an elevated serum levels of ALT and ALT to AST ratio, as indicators of development of NAFLD.

Development and Pilot Testing of the Snackability Smartphone Application to Identify Healthy and Unhealthy Snacks

Objectives

Snacks contribute to the diet quality in youth, which is often poor. Although the US Department of Agriculture (USDA) has guidelines for healthy snacks, this is lost in translation when youth are choosing snacks. To develop a user-friendly app to help identify healthy snacks based on the US Department of Agriculture guidelines and evaluate the app's feasibility, usability, satisfaction, and acceptability.

Methods

The ‘Snackability’ app was developed following the ADDIE (analysis, design, development, implementation, and evaluation) model. The app was pilot tested for 2 weeks among college-age students (18–24 years) using questionnaires and focus groups. Based on the feedback received, the app was improved, and pilot-tested again.

Results

The app had a simple score (−1 to 11) and feedback (the higher the score, the healthier the snack is). The 1st pilot test among 12 students showed that the app's feasibility and usability were >50% (p < 0.05). Participants reported that the app was a good way to help individuals select and consume healthy snacks and suggested improving the search process and including average score reports, a ‘consumed history’ tab, gamification, notifications, and the option to add snacks not found. These were incorporated into the 2nd version of the app, which was pilot tested among 8 students. Feasibility, usability, and acceptability of the 2nd version were >50% (p < 0.05). Additional suggestions were to include images for serving size, snack alternatives, and barcode scanning, which were incorporated into the 3rd version.

Conclusions

Snackability app was feasible, usable, satisfactory, and acceptable, and several features were improved as suggested by participants.

Eating frequency and weight status in Portuguese children aged 3-9 years: results from the cross-sectional National Food, Nutrition and Physical Activity Survey 2015-2016

OBJECTIVE

To evaluate daily eating frequency (main meals and snacks) in relation to weight status in children aged 3-9 years, representative of the Portuguese population.

DESIGN

Cross-sectional study. Dietary intake was estimated as the mean of two non-consecutive days of food diaries, followed by face-to-face interviews. Weight and height were measured by trained observers. Eating occasions (EO) were defined by the children's caregiver; an EO was considered separate if the time of consumption was different from other EO and it provided at least 209 kJ (50 kcal). Main meals defined as 'breakfast', 'lunch' and 'dinner' could be selected only once per day. The remaining EO were considered snacks. The association between eating frequency and overweight/obesity was evaluated through logistic regressions weighted for the population distribution.

SETTING

National Food, Nutrition and Physical Activity Survey of the Portuguese population, 2015-2016.

PARTICIPANTS

Portuguese children aged 3-9 years with complete dietary data and anthropometric measurements (n 517).

RESULTS

Overall, the number of daily EO ranged from 3·5 to 11, and on average children had 5·7 daily EO. After adjustment for child's sex, age and total energy intake, and considering only plausible energy intake reporters, having < 3 snacks/d was positively associated with being overweight/obese (OR = 1·98; 95 % CI 1·00, 3·90), compared with having ≥ 3 snacks/d.

CONCLUSIONS

Lower daily frequency of EO was associated with increased odds of being overweight or obese in children. A higher eating frequency, maintaining the same energy intake, seems to contribute to a healthy body weight in children.

Association of nuts and unhealthy snacks with subclinical atherosclerosis among children and adolescents with overweight and obesity

Background

The process of atherosclerosis begins early in childhood and usually remains asymptomatic until later in life. Carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis could identify early vascular alterations. Unhealthy snacks consumption is associated with obesity and other CVD risk factors in children and adolescents. The aim of this study is to investigate the association of different snack substitution and cIMT among overweight and obesity children and adolescents.

Methods

A total of 339 participants aged 6 to 13 years with the body mass index Z score ≥ 1 based on WHO criteria enrolled in this study. We measured food intakes of participants by validate and reliable food frequency questionnaire (FFQ). Carotid intima media thickness was measured in the common carotid artery with high-resolution ultrasonography.

Results

After controlling for confounders, intake of nuts had a negative relationship with cIMT (β = 0.135 mm P value = 0.009). Moreover, participants in the last tertile of nuts intake had 59% lower risk of high cIMT in comparison with those who consumed less than 0.64 serving/wk./1000Kcal of nuts (P for trend = 0.010). Substituted of nuts intake with sweet unhealthy snacks had a negative relationship with cIMT (β = 0.15 mm). There was no other significant association between energy-dense nutrient-poor solid snacks and cIMT.

Conclusions

Our findings emphasize the impact of nuts consumption as a healthy snack on subclinical stages atherosclerosis. Clinical trial studies could examine the effect of different kinds of nuts consumption on cIMT and complications of CVD risk factors.

Electronic supplementary material

The online version of this article (10.1186/s12986-019-0350-y) contains supplementary material, which is available to authorized users.

Dissemination of healthy kids out of school principles for obesity prevention: A RE-AIM analysis

Health-promoting behaviors for childhood obesity prevention are needed across multiple environments where children spend time, including out-of-school time (OST). Therefore Healthy Kids Out of School (HKOS) developed intervention strategies to promote three evidence-based principles (Drink Right, Move More, Snack Smart) for obesity prevention in OST. The strategies were developed with stakeholder input, disseminated, and evaluated (2012-2015) in two volunteer-led OST organizations, Boy Scouts of America (BSA) and 4-H, across three US states using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Mixed methods were used involving surveys, key informant interviews, and organizational-level data collection. Sixty out of 81 (74.1%) BSA districts and 4-H counties reaching 84,590 children (72% of children participating in BSA and 4-H in three states) adopted the strategies. 530 surveys completed by local OST leaders at baseline and 294 at follow-up showed the percentage of programs offering healthy beverages and opportunities for physical activity increased from baseline to follow-up (beverages 26% baseline, 35% follow-up, odds ratio (OR) 1.53; physical activity 31% baseline, 45% follow-up, OR 1.79; all p < 0.05). The increasing trend for healthy snacks was statistically non-significant (p = 0.09). Leaders interviewed reported the strategies were easy to implement, a good fit with their program, facilitated success, and they expected to maintain the changes. Integration of HKOS customized materials (BSA patch and 4-H pin) on BSA and 4-H national websites is a broader indicator of maintenance. Intervention strategies developed with stakeholder input and disseminated with training can effectively facilitate healthy environments for children, and have potential for national scale.

Timing of eating across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study

OBJECTIVE

To examine timing of eating across ten European countries.

DESIGN

Cross-sectional analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study using standardized 24 h diet recalls collected during 1995-2000. Eleven predefined food consumption occasions were assessed during the recall interview. We present time of consumption of meals and snacks as well as the later:earlier energy intake ratio, with earlier and later intakes defined as 06.00-14.00 and 15.00-24.00 hours, respectively. Type III tests were used to examine associations of sociodemographic, lifestyle and health variables with timing of energy intake.

SETTING

Ten Western European countries.

SUBJECTS

In total, 22 985 women and 13 035 men aged 35-74 years (n 36 020).

RESULTS

A south-north gradient was observed for timing of eating, with later consumption of meals and snacks in Mediterranean countries compared with Central and Northern European countries. However, the energy load was reversed, with the later:earlier energy intake ratio ranging from 0·68 (France) to 1·39 (Norway) among women, and from 0·71 (Greece) to 1·35 (the Netherlands) among men. Among women, country, age, education, marital status, smoking, day of recall and season were all independently associated with timing of energy intake (all P<0·05). Among men, the corresponding variables were country, age, education, smoking, physical activity, BMI and day of recall (all P<0·05).

CONCLUSIONS

We found pronounced differences in timing of eating across Europe, with later meal timetables but greater energy load earlier during the day in Mediterranean countries compared with Central and Northern European countries.

[Problematic Eating Behaviors after Bariatric Surgery: A National Study with a Portuguese Sample]

INTRODUCTION

Bariatric surgery is the most effective method for the treatment of morbid obesity. However, the development of eating psychopathology and the emergence of problematic eating behaviours have been reported in the literature. The aim of this crosssectional study was to characterize the post-bariatric population in terms of the frequency of problematic eating behaviours over time and to understand the related psychological features.

MATERIAL AND METHODS

This sample was composed of 155 bariatric patients that responded to several self-reported instruments assessing eating psychopathology, problematic eating behaviours, anxiety, depression and stress and impulsive behaviour.

RESULTS

Results showed that grazing, binge eating, concerns about body weight and shape, and negative urgency are significantly more frequent at 24 months after bariatric surgery (when compared to earlier postoperative assessments). Correlational analyses showed that eating psychopathology and problematic eating behaviours were significantly and positively associated with levels of anxiety, depression, stress and negative urgency. This study also reinforces the mediating role of negative urgency in the relationship between time elapsed since surgery and psychological distress, and problematic eating behaviours, accounting for a total of 32.3% and 27.2% of its variance, respectively.

DISCUSSION

The results suggest a growing trend of problematic eating behaviours and levels of impulsivity being reported by bariatric patients over time.

CONCLUSION

Given the established evidence that supports its impact on weight variability, early identification of problematic eating behaviours and of patients with a tendency to act impulsively in situations of negative emotionality should be a central concern in the follow-up of the bariatric population.

Cross-cultural effects of food product familiarity on sensory acceptability and non-invasive physiological responses of consumers

This research evaluated the effects of product familiarity on the sensory acceptability and physiological responses of consumers toward different food stimuli using two populations (Asian vs. Western). Two studies were conducted: (1) an online questionnaire and (2) a tasting session. For (1), n = 102 (60% Asians and 40% Westerners) evaluated 31 food items visually for familiarity and liking whereas for (2), participants (n = 60; 48% Asians and 52% Westerners) evaluated 10 different foods (tortoise jelly, chili slices, beef jerky, dried tofu, Vegemite®, durian cake, octopus chips, chocolate, corn chips, and wasabi coated peas) by tasting for familiarity and liking (visual/aroma/taste/texture/overall). A novel Android® app (Bio-sensory App) was used to capture sensory and non-invasive physiological responses (temperature, heart rate and facial expressions) of consumers. In (1), Asian and Western participants differed in their familiarity scores, visual liking ratings, and the selection of emotion terms for the stimuli. In (2), cultural differences affected familiarity and the liking scores of appearance, aroma, taste and texture of the products. While food stimuli marginally affected the physiological responses of consumers for both cultures, Asian participants elicited higher temperature values compared to those of Westerners. Both studies (1 and 2) showed that familiarity of food products was positively associated to sensory liking for both cultural groups. These findings are useful to understand consumers acceptability based on both sensory and physiological responses.

Consuming snacks mid-afternoon compared with just after lunch improves mean amplitude of glycaemic excursions in patients with type 2 diabetes: A randomized crossover clinical trial

AIMS

Our aim was to explore the acute effects of consuming snacks at different times on glucose excursions in patients with type 2 diabetes (T2D).

METHODS

Seventeen patients with T2D [means±SD: age 67.4±9.4-years; BMI 23.5±3.1kg/m²; HbA_1c 55±6mmol/mol (7.2±1.0%)] were randomly assigned in this crossover study. Each participant wore a continuous glucose monitoring device for 4 days and consumed identical test meals on the second and third days, comprising breakfast at 0700h, lunch at 1200h and dinner at 1900h. Half the participants consumed 75kcal biscuits at 1230h (just after lunch) on the second day and at 1530h (mid-afternoon) on the third day, while the other half consumed snacks at the same times, but vice versa. Each patient's glucose parameters were compared against baseline for the 2days of snacking at different times of day.

RESULTS

Consuming snacks in the mid-afternoon led to significantly lower mean amplitudes of glycaemic excursions (mean±SEM: 5.19±0.48 vs. 6.90±0.69mmol/L, P<0.01; standard deviation: 1.75±0.17 vs. 2.16±0.21mmol/L, P<0.01) and incremental areas under the curve for glucose after dinner (479±76 vs. 663±104mmol/L per min, P<0.01) compared with snacking just after lunch, whereas mean glucose levels did not differ over the 2days.

CONCLUSION

These results suggest that consuming snacks well separated from lunch may be an effective way to suppress postprandial glucose levels and glycaemic excursions.

Eating patterns of Australian adults: associations with blood pressure and hypertension prevalence

PURPOSE

Eating patterns have been linked to obesity, an established risk factor for hypertension; however, their contribution to hypertension is poorly understood. This study aimed to examine associations of frequency of meals, snacks and all eating occasions (EO), and temporal eating patterns, with blood pressure (BP) and hypertension.

METHODS

Dietary data collected via two 24-h recalls during the 2011-2012 Australian National Nutrition and Physical Activity Survey (n = 4482 adults, ≥ 19 years) were analysed. Frequencies of EO, meals, and snacks were calculated. Temporal eating patterns were determined using latent class analysis. Multivariate regression models assessed associations of eating patterns with systolic BP (SBP), diastolic BP (DBP), and hypertension prevalence.

RESULTS

Among men, a higher snack frequency was inversely associated with DBP [β = - 0.59, 95% confidence interval (CI) (- 1.12, - 0.07)] and hypertension [odds ratio (OR) 0.86, 95% CI (0.75, 0.98)] after adjustment for covariates and BMI. However, these associations disappeared after additional adjustment for total energy intake and overall diet quality. Among women, a temporal eating pattern characterized by a later "lunch" meal was associated with SBP [β = 2.45, 95% CI (0.05, 4.84)], DBP [β = 1.69, 95% CI (0.25, 3.13)], and hypertension [OR = 1.49, 95% CI (1.00, 2.22)], when compared to a "conventional" eating pattern.

CONCLUSIONS

In this study, an inverse association found between snack frequency and BP among men disappeared after adjustment for dietary factors and a "later lunch" pattern was associated with higher BP in women. Future research is needed to understand the relationship and potential mechanistic pathways between eating patterns and BP.

The benefits of defining "snacks"

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

Sweetened beverages, snacks and overweight: findings from the Young Lives cohort study in Peru

Objective

To determine the association between consumption of snacks and sweetened beverages and risk of overweight among children.

Design

Secondary analysis of the Young Lives cohort study in Peru.

Setting

Twenty sentinel sites from a total of 1818 districts available in Peru.

Subjects

Children in the younger cohort of the Young Lives study in Peru, specifically those included in the third (2009) and the fourth (2013) rounds.

Results

A total of 1813 children were evaluated at baseline; 49·2 % girls and mean age 8·0 (sd 0·3) years. At baseline, 3·3 (95 % CI 2·5, 4·2) % reported daily sweetened beverage consumption, while this proportion was 3·9 (95 % CI 3·1, 4·9) % for snacks. Baseline prevalence of overweight was 22·0 (95 % CI 20·1, 23·9) %. Only 1414 children were followed for 4·0 (sd 0·1) years, with an overweight incidence of 3·6 (95 % CI 3·1, 4·1) per 100 person-years. In multivariable analysis, children who consumed sweetened beverages and snacks daily had an average weight increase of 2·29 (95 % CI 0·62, 3·96) and 2·04 (95 % CI 0·48, 3·60) kg more, respectively, than those who never consumed these products, in approximately 4 years of follow-up. Moreover, there was evidence of an association between daily consumption of sweetened beverages and risk of overweight (relative risk=2·12; 95 % CI 1·05, 4·28).

Conclusions

Daily consumption of sweetened beverages and snacks was associated with increased weight gain v. never consuming these products; and in the case of sweetened beverages, with higher risk of developing overweight.

Copycat snacks: Can students differentiate between school and store snacks?

In 2014, the national Smart Snacks in School nutrition standards placed regulations on all snack foods sold in schools. Many food companies reformulated common snack food products for sale in schools, called "copycat snacks", which look similar to nutritionally different foods sold in stores. It is possible that these snacks create consumer confusion among students. The purpose of this study was to determine if middle school students could differentiate, in taste and appearance, between school (copycat) and store versions of common snacks. Seventy-six middle school students evaluated three different food products offered in schools: Froot Loops, Rice Krispy Treats, and Doritos. Students tasted snacks in a series of triangle tests for difference, one for each snack food, including school and store versions. Students were also presented with packages, school and store versions of the same products, and asked to determine the expected taste, purchase intentions, and perceived healthfulness. Students could determine taste differences between school and store Rice Krispy Treats yet could not differentiate between Froot Loop and Dorito varieties. Students rated store versions of all three snacks with greater expected taste, higher intention to purchase, and as less healthy. While it seems product confusion concerning copycat snacks may not be severe in this sample, snack food brands are still a prominent feature in schools. It is possible that these copycat snacks can confuse students' perceptions of healthy foods. Alternative packaging for school foods or reformation of store versions of snack foods may be viable solutions to this problem.

No Improvements in Postnatal Dietary Outcomes Were Observed in a Two-Arm, Randomized, Controlled, Comparative Impact Trial among Rural, Southern, African-American Women

BACKGROUND

Suboptimal diet quality, prevalent among postpartum women, is troubling for mothers and their children because positive relationships between maternal and child diet quality exist.

OBJECTIVE

The primary objective was to determine whether postnatal diet quality scores of participants in the two treatment arms differed or changed over time.

DESIGN

Delta Healthy Sprouts was a two-arm, randomized, controlled, comparative impact trial.

PARTICIPANTS AND SETTING

Pregnant women at least 18 years of age, less than 19 weeks pregnant, and residing in three Mississippi counties were recruited between March 2013 and December 2014. Postnatal data was collected from 54 participants between September 2013 and May 2016. The postnatal attrition rates were 17% and 13% for the control and experimental arms.

INTERVENTION

The control arm received the Parents as Teachers curriculum, and the experimental arm received a nutrition- and physical activity-enhanced Parents as Teachers curriculum.

MAIN OUTCOME MEASURES

Multiple-pass 24-hour dietary recalls were collected from participants at the postnatal month 1, 4, 6, 8, and 12 visits. Healthy Eating Index-2010 was used to calculate diet quality.

STATISTICAL ANALYSIS PERFORMED

Linear mixed models were used to test for treatment, time, and treatment by time (interaction) effects on postnatal dietary outcomes.

RESULTS

Control arm mean (95% confidence limits) total Healthy Eating Index-2010 scores were 36.8 (range=32.5 to 41.1), 36.5 (range=31.9 to 41.1), 40.2 (range=35.7 to 44.8), 39.3 (range=34.7 to 43.9), and 36.4 (range=31.8 to 41.0) at postnatal months 1, 4, 6, 8, and 12, respectively. Corresponding experimental arm scores were 42.3 (range=37.5 to 47.0), 41.6 (range=36.3 to 46.9), 40.2 (range=34.8 to 45.7), 45.8 (range=40.5 to 51.1), and 37.6 (range=32.6 to 42.7), respectively. Experimental scores were significantly higher than control scores across time. No other effects were significant.

CONCLUSIONS

Neither the standard Parents as Teachers curriculum nor the enhanced Parents as Teachers curriculum was effective at improving the poor diet quality of this cohort of rural, Southern, African-American women during the 12 months following the birth of their infant.

Associations between sedentary behaviours and dietary intakes among adolescents

OBJECTIVE

The purpose of the current study was to examine associations of individual and aggregated screen-based behaviours, and total sitting time, with healthy and unhealthy dietary intakes among adolescents.

DESIGN

Cross-sectional study of adolescents. Participants self-reported durations of television viewing, computer use, playing electronic games (e-games), total sitting time, daily servings of fruits and vegetables, and frequency of consumption of sugar-sweetened beverages (SSB), diet beverages, fast foods and discretionary snacks. Logistic regression models were conducted to identify associations of screen-based behaviours, total screen time and total sitting time with dietary intakes.

SETTING

Victoria, Australia.

SUBJECTS

Adolescents (n 939) in School Year 11 (mean age 16·8 years).

RESULTS

The results showed that watching television (≥2 h/d) was positively associated with consuming SSB and diet beverages each week and consuming discretionary snacks at least once daily, whereas computer use (≥2 h/d) was inversely associated with daily fruit and vegetable intake and positively associated with weekly fast-food consumption. Playing e-games (any) was inversely associated with daily vegetable intake and positively associated with weekly SSB consumption. Total screen (≥2 h/d) and sitting (h/d) times were inversely associated with daily fruit and vegetable consumption, with total screen time also positively associated with daily discretionary snack consumption and weekly consumption of SSB and fast foods.

CONCLUSIONS

Individual and aggregated screen-based behaviours, as well as total sitting time, are associated with a number of indicators of healthy and unhealthy dietary intake. Future research should explore whether reducing recreational screen time improves adolescents' diets.

The influence of frequently consumed beverages and snacks on dental erosion among preschool children in Saudi Arabia

Background

To determine the prevalence of dental erosion and its association to commonly used beverages and snacks among 3 to 5 year old preschool children in Riyadh, Saudi Arabia.

Methods

Three hundred eighty-eight preschool children between 3 and 5 years old were selected from 10 different schools using a cluster random sample selection; there were 184 (47%) boys and 204 (53%) girls. The surfaces of each tooth were examined for erosion, and the level of tooth wear was recorded. Data on the frequently used beverages and snacks were obtained by questionnaires completed by the parents of the preschool children.

Results

Among the 388 children examined, 47% exhibited low erosion, 10% exhibited moderate erosion and 4% exhibited severe erosion. There was no statistically significant difference between boys and girls in terms of the prevalence of erosion. Sixty percent of the children regularly consumed juice drinks. Among daily consumers, 84% of children showed erosion prevalence with strongly significant association (p < 0.005). Holding the drink in the mouth also showed a significant association with erosion (p < 0.02).

Conclusion

It was concluded that an association was found between the prevalence of dental erosion and the frequency of citrus and carbonated juice consumed by the preschool children in Saudi Arabia.

Food parenting and child snacking: a systematic review

Background

While the role of parenting in children’s eating behaviors has been studied extensively, less attention has been given to its potential association with children’s snacking habits. To address this gap, we conducted a systematic review to describe associations between food parenting and child snacking, or consuming energy dense foods/foods in between meals.

Methods

Six electronic databases were searched using standardized language to identify quantitative studies describing associations of general and feeding-specific parenting styles as well as food parenting practices with snacking behaviors of children aged 2–18 years. Eligible peer-reviewed journal articles published between 1980 and 2017 were included. Data were extracted using a standard protocol by three coders; all items were double coded to ensure consistency.

Results

Forty-seven studies met inclusion criteria. Few studies focused on general feeding (n = 3) or parenting styles (n = 10). Most studies focused on controlling food parenting practices (n = 39) that were not specific to snacking. Parental restriction of food was positively associated with child snack intake in 13/23 studies, while pressure to eat and monitoring yielded inconsistent results. Home availability of unhealthy foods was positively associated with snack intake in 10/11 studies. Findings related to positive parent behaviors (e.g. role modeling) were limited and yielded mixed results (n = 9). Snacking was often assessed using food frequency items and defined post-hoc based on nutritional characteristics (e.g. energy-dense, sugary foods, unhealthy, etc.). Timing was rarely included in the definition of a snack (i.e. chips eaten between meals vs. with lunch).

Conclusions

Restrictive feeding and home access to unhealthy foods were most consistently associated with snacking among young children. Research is needed to identify positive parenting behaviors around child snacking that may be used as targets for health promotion. Detailed definitions of snacking that address food type, context, and purpose are needed to advance findings within the field. We provide suggested standardized terminology for future research.

Electronic supplementary material

The online version of this article (10.1186/s12966-017-0593-9) contains supplementary material, which is available to authorized users.

Whey protein supplementation 2 hours after a lower protein breakfast restores plasma essential amino acid availability comparable to a higher protein breakfast in overweight adults

Amino acids from meals peak in the plasma at ~180 minutes postprandial. Conversely, amino acids from rapidly digestible whey protein appear in the plasma within 15 minutes and peak at 60 minutes postprandial. Therefore, we hypothesized that consuming a 20-g whey protein snack 2 hours after a standard mixed-macronutrient, lower protein breakfast (10 g) would result in peak and composite postprandial plasma essential amino acid (EAA) responses that were not different from consuming a 30-g protein breakfast alone. Using a randomized, crossover design, 12 subjects (6 men, 6 women; age: 29 ± 1 y; BMI: 26.0 ± 1.0 kg/m²; mean ± SE) completed three 330-minute trials in which they consumed breakfasts containing (i) 10 g of protein (10-PRO, control), (ii) 30 g of protein (30-PRO), and (iii) 10 g of protein followed by 20 g of whey protein isolate 120 minutes later (10/20-PRO). For both 30-PRO and 10/20-PRO, EAA peaked 180 minutes after breakfast, with greater peak concentrations for 10/20-PRO than 30-PRO (Tukey adjusted, P < .0001). Essential amino acid positive incremental areas under the curve (iAUCpos) over 300 minutes were not different between 30-PRO and 10/20-PRO. Consuming a rapidly digested whey protein snack 2 hours after a slowly digested, lower protein breakfast resulted in a greater peak plasma EAA concentration but comparable plasma EAA availability than consuming a single higher protein breakfast.