Snack frequency, size, and energy density are associated with diet quality among US adolescents

Abstract

Objective: Evaluate snacking and diet quality among U.S. adolescents. Design: Cross-sectional analysis examined snack frequency (snacks/day), size (kcal/snack), and energy density (kcal/g/snack) as predictors of diet quality using the mean of two 24-hr dietary recalls. Diet quality was assessed using the Healthy Eating Index (HEI-2015, 0-100), a mean adequacy ratio (MAR, 0-100) for under consumed nutrients (potassium, fiber, calcium, vitamin D), and mean percent of recommended limits for over-consumed nutrients (added sugar, saturated fat, sodium). Linear regression models examined total snacks, food only snacks, and beverage only snacks, as predictors of diet quality adjusting for demographic characteristics and estimated energy reporting accuracy. Setting: 2007-2018 National Health and Nutrition Examination Survey. Participants: Adolescents 12-19 years (n=4,985). Results: Snack frequency was associated with higher HEI-2015 (β=0.7(0.3), p<.05), but also with higher intake of over-consumed nutrients (β=3.0 (0.8), p≤.001). Snack size was associated with lower HEI (β= -0.005(0.001), p≤.001) and MAR (β=-0.005 (0.002), p<.05), and higher intake of over-consumed nutrients (β=0.03 (0.005), p≤.001). Associations differed for food only and beverage only snacks. Food only snack frequency was associated with higher HEI-2015 (β= 1.7(0.03), p≤.001), while food only snack size (β=-0.006(0.0009), p≤.001) and food only snack energy density (β=-1.1 (0.2), p≤.001) were associated with lower HEI-2015. Conversely, beverage only snack frequency (β=4.4(2.1), p<.05) and beverage only snack size (β=0.03(0.01), p≤.001) were associated with higher intake of over-consumed nutrients. Conclusions: Smaller, frequent, less energy dense food only snacks are associated with higher diet quality in adolescents; beverages consumed as snacks are associated with greater intake of over-consumed nutrients.

Consumption of snack foods by children and adolescents and their parents' knowledge about substances added to food

“…The type of food consumed and its appropriate quality are fundamental determinants of proper nutrition and, consequently, improved human health. Eating among children and adolescents is almost common and contributes significantly to increased consumption of energy and other nutrients [e. g. sugars, saturated fatty acids, salt or additives] by children, which is associated with an overall poorer diet [6]. Parents play an important role in shaping children's eating habits, including eating.…”

“…It is therefore worth taking care of the regularity of consumed meals and to shape the correct taste preferences and nutritional choices of children from an early age. Unhealthy snacks [e. g. sweets, crisps] can be replaced by fruit, vegetables or nuts, and carbonated and sweetened drinks can be replaced by water, fresh juices or milk drinks, and can then be classified as beneficial eating behaviours [6,7,12].…”

“…Excessive consumption of sugar or tasty foods can cause neurochemical and neurobiological changes, modifying behaviour by altering emotional processing. The studies have shown that the consumption of ultra-processed foods (compared to the availability/consumption of minimally processed foods) is associated with higher calorie intake and weight gain, leading to obesity or other health problems [6,10,33]. Sweeteners have been shown to contribute to the development of metabolic syndrome and obesity epidemics through changes in the microbiome.…”

“…In the literature, snacks are defined as foods eaten between meals and are usually identified as foods with a higher energy density and low in nutrients. Snack foods include: sweets, cookies, chips, sweet drinks [5,6]. Sweet and salty snacks are one of the most popular and favorite products among children [7].…”

“…Excessive consumption of sugary foods may be due to the affordability, palatability, and convenience of sugary foods [8]. It is important to note that excessive 2 consumption of sugary/salty snacks replaces the consumption of important foods in the diet, such as fruit and vegetables, fermented dairy products, and thus leads to lower intake of key nutrients and lower diet quality [6,9]. On the other hand, insufficient intake of important nutrients by children and adolescents over a long period of time may result in impaired growth and development, as well as many other long-term health consequences [5,7,8,10].…”