Associations between Meal and Snack Frequency and Diet Quality in US Adults: National Health and Nutrition Examination Survey 2003-2012

Published:February 02, 2016DOI:



      The associations between eating frequency and diet quality are inconclusive, which might be a result of different effects of meal frequency and snack frequency.


      This cross-sectional study examined the associations of eating frequency, meal frequency, and snack frequency with diet quality, based on data from the National Health and Nutrition Examination Survey 2003-2012.


      Dietary intake was assessed in 19,427 US adults aged 20 years or older, using two 24-hour dietary recalls. All eating occasions providing ≥50 kcal were divided into either meals or snacks on the basis of contribution to daily energy intake (≥15% or <15%), self-report, and time (6 am to 10 am, 12 pm to 3 pm, and 6 pm 9 pm or others). Diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010).

      Statistical analyses performed

      Linear regression analyses were performed to explore the associations of eating frequency, meal frequency, and snack frequency (independent variables) with dietary intake variables (dependent variables).


      Higher eating frequency was modestly and positively associated with higher HEI-2010 in both men and women; one additional eating occasion per day increased HEI-2010 by 1.77 points in men and 2.22 points in women (both P<0.0001). All measures of meal frequency and snack frequency were also modestly and positively associated with HEI-2010 in both sexes, irrespective of the definition of meals and snacks. However, the associations were stronger for meal frequency than for snack frequency; one additional meal per day increased HEI-2010 by 2.14 to 5.35 points, and one additional snack per day increased HEI-2010 by 1.25 to 1.97 points (all P<0.0001).


      In a representative sample of US adults, both meal frequency and snack frequency were modestly associated with better diet quality.


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      K. Murakami is an associate professor, Department of Nutrition, School of Human Cultures, University of Shiga Prefecture, Hikone, Japan.


      M. B. E. Livingstone is a professor, Northern Ireland Centre for Food and Health, Ulster University, Coleraine, UK.