The Contribution of Snacking to Overall Diet Intake among an Ethnically and Racially Diverse Population of Boys and Girls

Published:November 25, 2019DOI:https://doi.org/10.1016/j.jand.2019.08.173

      Abstract

      Background

      Children in low-income and minority populations are at risk for poor dietary quality. At least one-third of the calories consumed by children are eaten between meals (ie, snacks). The contribution of snacking to diet quality among children is poorly understood.

      Objective

      The current study examined associations between snacking and children’s diet quality along with differences across ethnicity or race, sex, and weight status.

      Design

      Cross-sectional data came from Phase I of the Family Matters Study, an observational study.

      Participants/setting

      This study included 150 families with children aged 5 to 7 years old from six ethnic or racial groups (n=25 from each: African American, Hispanic, Hmong, Native American, Somali, non-Hispanic white); data were collected in Minneapolis–Saint Paul, MN in 2017-2018.

      Main outcome measures

      Total daily energy (kilocalories), overall diet quality using the Healthy Eating Index (HEI-2010), and food group intakes (eg, fruit, vegetables, refined grains, sugar-sweetened beverages [SSB]) were assessed using three 24-hour dietary recalls.

      Statistical analyses performed

      Conditional fixed effects estimators (within-child variation) were used in regression analyses to characterize the relationship between daily snacking and dietary intake relative to dietary intake at all other daily meal occasions. Mean (±standard deviation) overall dietary intake including all meals and snacks was compared with mean (±standard deviation) intake of meals only.

      Results

      Among boys, snacking was found to contribute positively to HEI-2010 scores (HEI-2010=57.6, HEI-2010 without snacks=55.0; effect size [ES]=0.28, P=0.03). Snacking was an important source of fruit (ES=0.71) and dairy (ES=0.53), but also contributed to children’s consumption of refined grains (ES=0.68) and SSB (ES=0.31). Very few vegetables were consumed as snacks. Furthermore, snacks contributed more to the overall diet quality (HEI-2010) of Native American (ES=0.30) and Somali (ES=0.35) youth as compared with youth from other ethnic or racial backgrounds.

      Conclusions

      Findings suggest that snacks have the potential to improve diet quality in children. Future research should examine influences on children’s food choices at snack times and barriers to serving more healthful foods as snacks that are faced by ethnically or racially diverse families.

      Keywords

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      References

        • Banfield E.C.
        • Liu Y.
        • Davis J.S.
        • Chang S.
        • Frazier-Wood A.C.
        Poor adherence to US dietary guidelines for children and adolescents in the national health and nutrition examination survey population.
        J Acad Nutr Diet. 2016; 116: 21-27
        • Pratt C.A.
        • Stevens J.
        • Daniels S.
        Childhood obesity prevention and treatment recommendations for future research.
        Am J Prev Med. 2008; 35: 249-252
        • Spiegel A.M.
        • Alving B.M.
        Executive summary of the Strategic Plan for National Institutes of Health Obesity Research.
        Am J Clin Nutr. 2005; 82: 211S-214S
        • Piernas C.
        • Popkin B.M.
        Trends in snacking among US children.
        Health Aff (Millwood). 2010; 29: 398-404
        • Piernas C.
        • Popkin B.M.
        Food portion patterns and trends among US children and the relationship to total eating occasion size, 1977–2006.
        J Nutr. 2011; 141: 1159-1164
        • Piernas C.
        • Popkin B.M.
        Increased portion sizes from energy-dense foods affect total energy intake at eating occasions in US children and adolescents: Patterns and trends by age group and sociodemographic characteristics, 1977–2006.
        Am J Clin Nutr. 2011; 94: 1324-1332
        • Jahns L.
        • Siega-Riz A.M.
        • Popkin B.M.
        The increasing prevalence of snacking among US children from 1977 to 1996.
        J Pediatr. 2001; 138: 493-498
        • Larson N.
        • Story M.
        A review of snacking patterns among children and adolescents: What are the implications of snacking for weight status?.
        Child Obes. 2013; 9: 104-115
        • Hess J.
        • Slavin J.
        • Hess J.
        • Slavin J.
        Snacking for a cause: Nutritional insufficiencies and excesses of U.S. children, a critical review of food consumption patterns and macronutrient and micronutrient intake of U.S. children.
        Nutrients. 2014; 6: 4750-4759
        • Dunford E.K.
        • Popkin B.M.
        37 year snacking trends for US children 1977-2014.
        Pediatr Obes. 2018; 13: 247-255
        • Shriver L.H.
        • Marriage B.J.
        • Bloch T.D.
        • et al.
        Contribution of snacks to dietary intakes of young children in the United States.
        Matern Child Nutr. 2018; 14e12454
        • Murakami K.
        • Livingstone M.B.E.
        Associations between energy density of meals and snacks and overall diet quality and adiposity measures in British children and adolescents: The National Diet and Nutrition Survey.
        Br J Nutr. 2016; 116: 1633-1645
        • Murakami K.
        Associations between nutritional quality of meals and snacks assessed by the Food Standards Agency nutrient profiling system and overall diet quality and adiposity measures in British children and adolescents.
        Nutrition. 2018; 49: 57-65
        • Llauradó E.
        • Albar S.A.
        • Giralt M.
        • Solà R.
        • Evans C.E.L.
        The effect of snacking and eating frequency on dietary quality in British adolescents.
        Eur J Nutr. 2016; 55: 1789-1797
        • Berge J.M.
        • Trofholz A.
        • Tate A.D.
        • et al.
        Examining unanswered questions about the home environment and childhood obesity disparities using an incremental, mixed-methods, longitudinal study design: The Family Matters study.
        Contemp Clin Trials. 2017; 62: 61-76
        • Population Reference Bureau. U.S
        low-income working families increasing.
        • Shiffman S.
        • Stone A.A.
        • Hufford M.R.
        Ecological momentary assessment.
        Annu Rev Clin Psychol. 2008; 4: 1-32
      1. NDSR Software. NCC Nutr Coord Cent. http://www.ncc.umn.edu/products/. Accessed September 30, 2019.

        • University of Minnesota
        Nutrition Coordinating Center (NCC). NDSR Support.
        http://www.ncc.umn.edu/ndsr-support/
        Date accessed: July 10, 2019
        • University of Minnesota
        Nutrition Coordinating Center (NCC). Healthy Eating Index (HEI).
        • Guenther P.M.
        • Kirkpatrick S.I.
        • Reedy J.
        • et al.
        The Healthy Eating Index-2010 is a valid and reliable measure of diet quality according to the 2010 Dietary Guidelines for Americans.
        J Nutr. 2014; 144: 399-407
        • Guenther P.M.
        • Casavale K.O.
        • Reedy J.
        • et al.
        Update of the healthy eating index: HEI-2010.
        J Acad Nutr Diet. 2013; 113: 569-580
        • National Institutes of Health
        National Cancer Institute. Choosing a method.
      2. Stata Statistical Software [computer program]. Release 15. College Station, TX: StataCorp LLC; 2017.

        • Johnson G.H.
        • Anderson G.H.
        Snacking definitions: Impact on interpretation of the literature and dietary recommendations.
        Crit Rev Food Sci Nutr. 2010; 50: 848-871
        • Wyse R.
        • Campbell E.
        • Nathan N.
        • Wolfenden L.
        Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: A cross-sectional study.
        BMC Public Health. 2011; 11: 938
        • Hanson N.I.
        • Neumark-Sztainer D.
        • Eisenberg M.E.
        • Story M.
        • Wall M.
        • others
        Associations between parental report of the home food environment and adolescent intakes of fruits, vegetables and dairy foods.
        Public Health Nutr. 2005; 8: 77-85
        • Cullen K.W.
        • Baranowski T.
        • Rittenberry L.
        • Cosart C.
        • Hebert D.
        • de Moor C.
        Child-reported family and peer influences on fruit, juice and vegetable consumption: Reliability and validity of measures.
        Health Educ Res. 2001; 16: 187-200
        • Neumark-Sztainer D.
        • Wall M.
        • Perry C.
        • Story M.
        Correlates of fruit and vegetable intake among adolescents: Findings from Project EAT.
        Prev Med. 2003; 37: 198-208
        • Nicklas T.A.
        • Baranowski T.
        • Baranowski J.C.
        • Cullen K.
        • Rittenberry L.
        • Olvera N.
        Family and child-care provider influences on preschool children’s fruit, juice, and vegetable consumption.
        Nutr Rev. 2001; 59: 224-235
        • Loth K.A.
        • MacLehose R.F.
        • Larson N.
        • Berge J.M.
        • Neumark-Sztainer D.
        Food availability, modeling and restriction: How are these different aspects of the family eating environment related to adolescent dietary intake?.
        Appetite. 2016; 96: 80-86
        • Arcan C.
        • Neumark-Sztainer D.
        • Hannan P.
        • van den Berg P.
        • Story M.
        • Larson N.
        Parental eating behaviours, home food environment and adolescent intakes of fruits, vegetables and dairy foods: Longitudinal findings from Project EAT.
        Public Health Nutr. 2007; 10: 1257-1265
        • Orlet Fisher J.
        • Mitchell D.C.
        • Wright H.S.
        • Birch L.L.
        Parental influences on young girls’ fruit and vegetable, micronutrient, and fat intakes.
        J Am Diet Assoc. 2002; 102: 58-64
        • Trofholz A.C.
        • Tate A.D.
        • Draxten M.L.
        • et al.
        What’s being served for dinner? An exploratory investigation of the associations between the healthfulness of family meals and child dietary intake.
        J Acad Nutr Diet. 2017; 117: 102-109
        • Neumark-Sztainer D.
        • MacLehose R.
        • Loth K.
        • Fulkerson J.A.
        • Eisenberg M.E.
        • Berge J.
        What’s for dinner? Types of food served at family dinner differ across parent and family characteristics.
        Public Health Nutr. 2014; 17: 145-155
        • Zachary D.A.
        • Palmer A.M.
        • Beckham S.W.
        • Surkan P.J.
        A framework for understanding grocery purchasing in a low-income urban environment.
        Qual Health Res. 2013; 23: 665-678
        • Fisher J.O.
        • Wright G.
        • Herman A.N.
        • et al.
        “Snacks are not food”. Low-income, urban mothers’ perceptions of feeding snacks to their preschool-aged children.
        Appetite. 2015; 84: 61-67
        • Gemming L.
        • Ni Mhurchu C.
        Dietary under-reporting: What foods and which meals are typically under-reported?.
        Eur J Clin Nutr. 2016; 70: 640-641
        • Foster E.
        • Bradley J.
        Methodological considerations and future insights for 24-hour dietary recall assessment in children.
        Nutr Res. 2018; 51: 1-11
        • Thompson F.E.
        • Kirkpatrick S.I.
        • Subar A.F.
        • et al.
        The National Cancer Institute’s dietary assessment primer: A resource for diet research.
        J Acad Nutr Diet. 2015; 115: 1986-1995

      Biography

      K. A. Loth is an assistant professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.

      Biography

      A. Trofholz is a research study coordinator, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.

      Biography

      J. M. Berge is a professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.

      Biography

      A. D. Tate is an assistant professor, Department of Epidemiology and Biostatistics, Univeristy of Georgia, Athens; at the time of the study, he was a PhD student, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.

      Biography

      J. Orlet Fisher is a professor, Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA.

      Biography

      D. Neumark-Sztainer is a professor, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.