The increasing prevalence of snacking among US children from 1977 to 1996

OBJECTIVES: To determine snacking trends and changes in nutrient contribution of snacking over time. STUDY DESIGN: Nationally representative data from the 1977-78 Nationwide Food Consumption Survey (NFCS77), 1989-91 Continuing Survey of Food Intake by Individuals (CSFII89), and 1994-96 (CSFII96) were used. The sample consisted of 21,236 individuals aged 2 to 18 years. METHODS: For each survey year, mean numbers of snacks consumed, mean grams consumed per snack, and mean energy intake from snacks were computed, as was contribution of snacking to total energy intake and fat intake. Snacking was self-defined, and a snacking occasion consisted of all snack foods consumed during a 15-minute period. Differences in means between age groups and across survey years were compared. RESULTS: The prevalence of snacking increased in all age groups. The average size of snacks and energy per snack remained relatively constant; however, the number of snacking occasions increased significantly, therefore increasing the average daily energy from snacks. Compared with non-snack eating occasions, the nutrient contribution of snacks decreased in calcium density and increased in energy density and proportion of energy from fat. CONCLUSION: Snacking is extremely prevalent in our society. Healthy snack food choices should be emphasized over high-energy density convenience snacks for children.     

High proportions of children under 3 years of age consume commercially produced snack foods and sugar‐sweetened beverages in Bandung City,Indonesia

Child undernutrition continues to be a national concern in Indonesia, whereas childhood overweight/obesity rises. Economic development has led to wide availability of highly processed foods and beverages, with growing evidence that children are consuming commercial snack products during the critical complementary feeding period. This study assessed the prevalence and patterns of consumption of commercially produced snack foods and sugar‐sweetened beverages among Indonesian children. A cross‐sectional survey was conducted with 495 mothers of children aged 6–35 months living in Bandung City, Indonesia. Among all children, 81.6% consumed a commercial snack food and 40.0% consumed a sugar‐sweetened beverage in the day preceding the interview. At 6–11 months, 46.5% of children consumed a snack food and 2.0% consumed a sugar‐sweetened beverage. Snack foods were consumed 3 or more times a day by 60.0% of children 24–35 months of age. Sweet biscuits and savory snacks were the most commonly consumed snack foods; sweetened milks and sweetened teas were the most common beverages. Maternal education, child age, and consumption of a commercially produced complementary food were associated with snack food consumption. Factors associated with sugar‐sweetened beverage consumption were child age and consumption of a commercially produced complementary food or breastmilk substitute. These findings reflect a high presence of processed, high‐sugar/salt commercial snack products in the diets of children 6–35 months. National attention should focus on interventions to reduce reliance on processed snack products and increase consumption of nutrient‐rich, locally available foods during the complementary feeding period.     

Contribution of snacks to dietary intakes of young children in the United States

Nutritional quality of children's diets is a public health priority in the fight against childhood obesity and chronic diseases. The main purpose of this study was to determine contribution of snacks to energy and nutrient intakes and to identify leading snack food sources of energy, total fat, and added sugars amongst young children in the United States. Using the 2005–2012 NHANES data, dietary intakes of 2‐ to 5‐year‐old children were analysed from a parent‐reported 24‐hour dietary recall (n = 3,429). Snacking occasions were aggregated to determine the proportion of total food/beverage intake obtained from snacks, estimate energy, and nutrient intakes, and identify the leading snack food sources of energy, added sugars, and total fat. Nearly all children consumed a snack on the reported day (62% morning, 84% afternoon, and 72% evening). Snacks accounted for 28% of total energy intake, 32% of carbohydrates, 39% of added sugars, and 26% of total fat and dietary fiber intakes for the day. Snacking occasions accounted for 46.6% of all beverages consumed on the reported day. Snacks and sweets food category (i.e., cookies and pastries) were the leading sources of energy (44%), total fat (52%), and added sugars (53%) consumed during snacking occasions. Sweetened beverages (e.g., fruit and sport drinks) contributed 1‐quarter of all added sugars obtained from snacks. Snacks contribute considerable amount of energy and nutrients to young children's diets, with a heavy reliance on energy‐dense foods and beverages. Targeted interventions are needed to improve the nutritional quality of snacks consumed by young children.     

Babies,soft drinks and snacks: a concern in low‐ and middle‐income countries?

Undernutrition in infants and young children is a global health priority while overweight is an emerging issue. Small‐scale studies in low‐ and middle‐income countries have demonstrated consumption of sugary and savoury snack foods and soft drinks by young children. We assessed the proportion of children 6–23 months of age consuming sugary snack foods in 18 countries in Asia and Africa using data from selected Demographic and Health Surveys and household expenditures on soft drinks and biscuits using data from four Living Standards Measurement Studies (LSMS). Consumption of sugary snack foods increased with the child's age and household wealth, and was generally higher in urban vs. rural areas. In one‐third of countries, >20% of infants 6–8 months consumed sugary snacks. Up to 75% of Asian children and 46% of African children consumed these foods in the second year of life. The proportion of children consuming sugary snack foods was generally higher than the proportion consuming fortified infant cereals, eggs or fruit. Household per capita daily expenditures on soft drinks ranged from $0.03 to $0.11 in three countries for which LSMS data were available, and from $0.01 to $0.04 on biscuits in two LSMS. Future surveys should include quantitative data on the purchase and consumption of snack foods by infants and young children, using consistent definitions and methods for identifying and categorising snack foods across surveys. Researchers should assess associations between snack food consumption and stunting and overweight, and characterise household, maternal and child characteristics associated with snack food consumption.     

儿童厌食症的危险因素研究

目的 探讨儿童厌食症的危险因素,以降低儿童厌食症的患病率。方法 采用问卷调查方式和病例对照研究方法收集150例厌食症儿童 （病例组）和150例正常儿童 （对照组）的一般资料,采用单因素分析和多因素logistic逐步回归分析研究儿童厌食症的危险因素。结果 单因素分析显示,病例组和对照组在添加辅食月龄、喂养方式、儿童是否喜欢肉食、是否喜欢蔬菜、是否喜欢咸食、是否常进食零食和/或饮料、是否边吃边玩、家长是否要求儿童按时进食等方面的差异有统计学意义 （P < 0.05）。多因素logistic回归分析显示,添加辅食时间晚 （OR=5.408）、常进食零食和/或饮料 （OR=11.813）、喜欢边吃边玩 （OR=6.654）是儿童厌食症的主要危险因素;而喜欢肉食 （OR=0.093）、喜欢蔬菜 （OR=0.272）以及家长要求儿童按时进食 （OR=0.079）是儿童厌食症的保护因素。结论 适时添加辅食、合理膳食、培养儿童正确的饮食和生活习惯可以减少儿童厌食症的发生。     

Perceptions of commercial snack food and beverages for infant and young child feeding: A mixed‐methods study among caregivers in Kathmandu Valley,Nepal

Ensuring nutritious complementary feeding is vital for child nutrition. Prior research in Kathmandu Valley found high consumption rates of commercially produced snack foods among young children, which are often energy‐dense/nutrient poor. This mixed‐methods study was conducted to elicit Nepali caregivers' perceptions of commercial snack foods and beverages and factors influencing their use for young child feeding. Seven facilitated focus group discussions (FGD) were conducted with Kathmandu Valley caregivers of children 12–23 months, and a survey of 745 primary caregivers of children 12–23 months of age was then conducted. During the FGD, caregivers reported commonly providing commercial food and beverage products to their children as snacks, and 98.6% of caregivers participating in the survey reported feeding their child such a food in the previous week. Because of processing and packaging, snack foods were not trusted by many FGD participants and considered as “junk foods” and not healthy for children. However, commercial snack foods were consistently ranked highly on convenience, both because of minimal preparation and ease of feeding; 48.5% of all surveyed caregivers reported providing a snack food because of convenience. Other family members' diets or provision of snack foods as treats also influenced children's consumption of these snack foods and beverages. This study indicates that caregivers of young children prefer snack options that are nutrient rich; however, this may conflict with preferences for foods that require minimal preparation and are appealing to young children. Such findings carry programmatic implications for interventions aiming to address children's diet quality in urban Nepal.     

Development of the Parental Modelling of Eating Behaviours Scale (PARM): links with food intake among children and their mothers

This study aimed to develop a self‐report questionnaire to explore parental modelling of eating behaviours and then to use the newly developed measure to investigate associations between parental modelling with healthy and unhealthy food intake in both mothers and their children. Mothers (n = 484) with a child aged between 18 months and 8 years completed the Parental Modelling of Eating Behaviours Scale (PARM), a new, self‐report measure of modelling, as well as a food frequency questionnaire. Principal components analysis of the PARM identified 15 items grouped into three subscales: verbal modelling (modelling through verbal communication); unintentional modelling (UM) (children adopting eating behaviours that parents had not actively modelled); and behavioural consequences (children's eating behaviours directly associated with parental modelling). The PARM subscales were found to be differentially related to food intake. Maternally perceived consequences of behavioural modelling were related to increased fruit and vegetable intake in both mothers and children. UM was related to higher levels of savoury snack intake in both mothers and their children. This study has highlighted three distinct aspects of parental modelling of eating behaviours. The findings suggest that mothers may intentionally model healthy food intake while unintentionally acting as role models for their children's less healthy, snack food intake.     

Food intake at age 8 2. Frequency, company and place of meals

In a sample of 141 healthy 8 year old children, over 95% had three main meals on each of the 4 days of the food record. Two-thirds had an afternoon snack and nearly one-half a morning snack on each of the 4 days, but only one-quarter had supper on each day.
Seventy-one per cent of all meals were eaten at home with the family, 20% at school with friends, and less than 1% of meals were eaten at a restaurant or fast food outlet. These data show that amongst children of primary school age, take away sources of food make a very small contribution to the diet, and that eating habits at home are of greatest importance to the child's diet.     

Food intake at age 8. 2. Frequency, company and place of meals

In a sample of 141 healthy 8 year old children, over 95% had three main meals on each of the 4 days of the food record. Two-thirds had an afternoon snack and nearly one-half a morning snack on each of the 4 days, but only one-quarter had supper on each day. Seventy-one per cent of all meals were eaten at home with the family, 20% at school with friends, and less than 1% of meals were eaten at a restaurant or fast food outlet. These data show that amongst children of primary school age, take away sources of food make a very small contribution to the diet, and that eating habits at home are of greatest importance to the child's diet.     

Value conflicts in mothers' snack choice for their 2‐ to 7‐year‐old children

Value conflicts appear when people experience struggles, doubts, and feelings of guilt when making food choices. This study aims to provide insight into value conflicts, which mothers may experience while providing snacks to their young children. Mothers are mainly responsible for providing the snacks their young children eat, making it a big responsibility for them as children's dietary behaviour tracks into adulthood. Possible value conflicts Dutch mothers (n = 136) experience while providing snacks to their 2‐ to 7‐year‐old children were investigated using food and motivation diaries and semi‐structured interviews. Differences between mothers' educational level, first versus not‐first child, and the differences in age of the children were taken into account. Results showed that the younger the children, the more value conflicts the mothers experienced. Mothers experienced most value conflicts when they provided snacks perceived as unhealthy. Six main value conflicts are elicited by this study, namely, conflicts between healthy and unhealthy snacks; conflicts between healthy and convenient snacks; conflicts related to providing snacks just before dinner; conflicts related to influence of others; conflicts when the child asks but the mother says “no”; and conflicts related to many unhealthy snacks at parties or visits. The insights gained in this study can be used for interventions to promote a healthier lifestyle, support the design of new snack products, and can give guidance for marketing challenges in global snack markets.     

Energy intake from unhealthy snack food/beverage among 12‐23‐month‐old children in urban Nepal

Unhealthy snack food and beverage (USFB) consumption among young children has been noted in many low‐income and middle‐income countries (LMIC), however, there is a lack of information on the contribution of these foods to children's diets in these contexts. This study describes the nutrient profiles and costs of snacks consumed by young children in Kathmandu Valley, Nepal, and assesses the proportion of total energy intake from nonbreastmilk foods (%TEI‐NBF) contributed by USFB and factors associated with high USFB consumption. A cross‐sectional survey was conducted among 745 randomly sampled primary caregivers of children aged 12–23 months. Of 239 unique snack foods and beverages consumed, 180 (75.3%) were classified as unhealthy based on nutrient profiling, with 158 of these being commercially branded. Median cost/100 kcal of USFB was lower as compared with healthy snacks. Ninety‐one percent of children had consumed a USFB in the previous 24 hr, with these foods contributing a mean %TEI‐NBF of 24.5 ± 0.7 among all children. Biscuits (10.8%), candy/chocolate (3.5%), and savoury snacks (3.4%) provided the largest %TEI‐NBF. Children who were older, female, or from the poorest households had significantly higher odds of high USFB consumption, whereas children whose caregivers were of upper caste/ethnicity or had achieved tertiary education had lower odds of consumption than other children. To reduce USFB consumption, interventions should seek to further understand social/cultural drivers of feeding practices, target disadvantaged populations, and ensure caregivers are fully aware of the nutritional quality of food products they choose for their children.     

伊朗东北部儿童代表性样本中儿童肥胖的膳食预测因素

目的：伊朗儿童的肥胖患病率不断升高。这项研究旨在评价伊朗东北部城市Neishabour的儿童代表性样本中肥胖的某些膳食决定因素。方法：在这项病例对照研究中,病例组为114名在校学生,年龄6~12岁,体重指数（BMI）≥第95个百分位（根据伊朗儿童的参考值）,而对照组为102名年龄和性别匹配的非肥胖同班同学。由受过训练的营养师在儿童在场的情况下与母亲面谈,进行两次24 h膳食回顾调查,收集了营养摄入数据;使用食物频率问卷调查了零食摄入模式;使用SPSS软件（第16版）进行了单因素和多因素logistic回归分析。结果：单因素logistic回归分析显示,总能量、蛋白质、碳水化合物、脂肪（包括饱和脂肪、单不饱和脂肪和多不饱和脂肪）和膳食纤维是学生肥胖的正向预测因素;玉米膨化食品、碳酸饮料、薯片、快餐食品和巧克力的摄入频率的粗估比值比（OR）有统计学意义。多因素logistic回归分析显示,肥胖与能量摄入量（OR = 2.489,95%CI：1.667~3.716）、玉米膨化食品摄入频率（OR=1.122,95%CI：1.007~1.250）及薯片摄入频率（OR=1.143,95%CI：1.024~1.276）显著相关;而膳食纤维摄入量（OR=0.909,95%CI：0.835~0.988）和天然果汁摄入量（OR= 0.601,95%CI：0.368~0.983）是预防肥胖的保护因素。结论：该研究结果证实了不健康饮食对儿童肥胖的作用,尤其是高热量零食。应鼓励儿童养成健康的饮食习惯,如摄入高纤维食物。     

Evaluation of the nutrition counselling component of a fitness programme for children with disabilities

OBJECTIVE: To describe and evaluate the nutrition counselling component of a fitness programme for children with disabilities. METHODS: Twenty-eight children with disabilities, ages 6-14 years, participated in a 16-week comprehensive fitness programme consisting of twice weekly exercise sessions, nutrition counselling and physical activity promotion education sessions. Nutrition sessions consisted of three individual and two group sessions. Individual nutrition goals were developed for each child using 3-day food intake diaries and parent interview. Body Mass Index (BMI) and progress towards nutrition goals were documented. RESULTS: No significant BMI changes were recorded for the entire group (n=28) or a sub-group with a goal to decrease BMI (n=8). Most of the children made improvements in individual goals indicating improvements in healthy eating habits. This included eating the daily recommended amount of servings of each food group, trying new foods and limiting foods containing saturated and trans fats, sodium and sugar. CONCLUSION: Short-term changes were noted in eating habits and behaviours during the 16-week fitness programme, although the effects did not influence overall BMI during the 16-week programme. Children with disabilities are at nutritional risk, and long-term follow-up is needed to determine if initial changes in parent-reported child eating behaviours will impact long-term nutrition, BMI and overall health.     

A comparison of infant and toddler feeding practices of mothers with and without histories of eating disorders

This preliminary study surveyed the feeding practices of mothers with eating disorder histories through evaluation of mothers' reported feeding styles, child diet composition and restrictive special approaches to feeding. For this non‐randomised cohort study, 25 mothers with eating disorder histories and 25 mothers with no history of an eating disorder with children ages 6–36 months were selected such that the groups were similar based on child age group and child sex. Mothers were compared on self‐reported feeding style using the Infant Feeding Styles Questionnaire and on child diet composition and special feeding approaches using a modified version of the Toddler Diet Questionnaire from the Women, Infants, and Children program. Mothers with eating disorder histories scored lower on the restrictive feeding style subscale than controls. No significant differences were detected between groups in child diet including the percentage of mothers who breastfed, duration of breastfeeding, age at solid food introduction, daily number of meals or snacks or daily frequency of consumption of fruits, vegetables or protein foods. Mothers with eating disorder histories were more likely to report taking a restrictive special approach to feeding such as limiting processed foods or feeding organic foods only. Although mothers with eating disorder histories may not differ greatly from control mothers in terms of child diet composition (smaller effects may not have been detected due to limited sample size), they may be more likely to take restrictive special approaches to feeding which mirror dietary rules common in individuals with eating disorders.     

Food-based recommendations to reduce fat intake: an evidence-based approach to the development of a family-focused child weight management programme

OBJECTIVES: To develop food-based recommendations to lower fat and energy intake for use in a family-focussed weight management programme for 6-9 year old children. METHODS: Secondary analysis of the 1995 National Nutrition Survey (NNS95) informed the development of food-based recommendations aiming to reduce fat and energy intake. Each recommendation was used to progressively modify a model 3-day high fat dietary intake with the accumulative effect on energy and nutrient intake of each recommendation assessed. RESULTS: Six to nine-year-olds in the NNS95 consuming 35-45% energy as fat (n= 280) consumed more total energy (mean +/- SD, 8671 +/- 2741 vs. 7571 +/- 2328 kJ/day) than children consuming a 'low fat' (23-27% energy as fat, n= 85) diet (P < 0.002). Food-based recommendations found to be most effective for reducing energy and fat intake included; changing to reduced fat milk, reducing intake of cereal-based and snack foods and replacing juice or soft drink with water. These changes, together with avoiding adding fat to vegetables and using sources of lean meat, reduced energy intake by approximately 10%, total fat intake by approximately 30% and saturated fat intake by 53%. CONCLUSIONS: Modifying six areas of food choices results in a moderate reduction in fat and energy intake. An eating pattern that is consistent with Australian dietary guidelines and uses foods commonly eaten by children is achievable for children aged 6-9 years. These food-based recommendations provide an evidence-based dietary framework for prevention and management of overweight in children.     

Consumption of highly processed snacks,sugar‐sweetened beverages and child feeding practices in a rural area of Nicaragua

Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar‐sweetened beverages (SSBs). All households with at least one child 0‐ to 35‐month‐old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0‐ to 1‐month‐olds and continued to be prevalent (60%) in the second year, while only 34% of the 0‐ to 5‐month‐olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6‐ to 11‐month‐old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6‐ to 8‐month‐olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long‐term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.     

Eating behavior in Prader-Willi syndrome, normal weight, and obese control groups

OBJECTIVE: Hyperphagia in Prader-Willi syndrome (PWS) is hypothesized to be due to hypothalamic dysfunction; thus the study of individuals with PWS might illustrate how hypothalamic dysfunction affects eating behavior. The aim of this study was to document the microstructure of the eating behavior in patients with PWS and to compare it with that of members of obese and normal weight control groups of the same age. STUDY DESIGN: Nine subjects with PWS (age, 10 +/- 4 years), 20 normal weight subjects (age, 12 +/- 3 years), and 20 obese subjects (age, 12 +/- 4 years) were served an excess lunch meal (hash) on a hidden scale built into a table and connected to a computer. The plate of food is placed on top of the scale, and when the food is eaten, the change in food weight is registered continuously. An eating curve is displayed online. After the meal, the eating data are fitted to a polynomial, and the computer calculates the amount of food eaten, time of consumption, eating rate (initial and total), and rate of deceleration. RESULTS: Subjects with PWS were found to have a longer duration of eating (P =.04) and a slower initial eating rate (P =. 01) compared with members of both obese and normal weight groups. In subjects with PWS, 56% of the eating curves were non-decelerating (linear or accelerating) compared with 10% of the normal weight group and 30% of the obese group (P =.02). CONCLUSION: The microstructure of the eating behavior in subjects with PWS differs from that of members of obese and normal weight control groups. Thus the eating behavior found in subjects with PWS might be due to decreased satiation rather than increased hunger.     

Restrained eating in overweight children: does eating style run in families?

Overweight children show abnormalities in eating style, such as restrained eating and tendency toward overeating (comprising both emotional and external eating). Family surroundings play a major role in developing eating behaviors in children. We tested whether restrained eating and tendency toward overeating predicted the amount of food intake in 41 overweight children (23 girls and 18 boys) and their parents (40 mothers and 11 fathers) after receiving a preload. We further investigated with questionnaires whether there were associations between the parents' and their children's eating behavior and whether mothers' food intake predicted the amount of food consumed by children in an experimental trial. We found that neither children with restrained eating nor their mothers ate more after a preload, but children with a high tendency toward overeating ate somewhat more after receiving a preload. Further analyses showed that children's food intake in the preload paradigm was predicted by mothers' food intake. Our findings point to a familial transmission of eating styles: children eat as their primary caregivers do, even when the caregivers are not present in the laboratory.     

Connections between parental eating attitudes and children's meagre eating: questionnaire findings

This study investigated whether young children's problematic, meagre eating is associated with the eating habits and attitudes of the parents. The subjects, 397 children, their mothers (n = 397) and fathers (n = 375) participated in a prospective atherosclerosis risk-factor intervention trial. The parents evaluated their own eating behaviour in questionnaires when their child was 13 mo old. The children's eating problems were recorded by the mothers when the child was 13 mo old, and by both parents when the child was 5 y old. At both ages, the weight and height of the children were measured. Problematic or maladaptive eating habits of the children were found to be connected to those of their parents. The mother's poor ability to enjoy eating, high tendency to snack and low tendency to eat only when hungry, as well as the father's difficulty in maintaining ideal weight significantly predicted persistent problems of meagre eating in their children. CONCLUSION: The study suggests that the eating habits and attitudes of parents may be reflected in the eating behaviour of young children.     

The glycaemic effect of simple sugars in mid-morning and afternoon snacks in childhood diabetes

Eighteen diabetic children ate three different snacks (free sucrose, sucrose plus fibre, fructose plus fibre) or had no snack on each of 4 mornings. Subsequently 10 children from this group took a standard snack (free sucrose) or no snack on two afternoons. In other respects the day of testing was standardised, the children going to school as normal and collecting their blood spots on filter paper for glucose analysis. There was no difference in the blood glucose profiles between different snacks or when no snack was taken either in the mornings or afternoon. This suggests both that moderate amounts of simple sugar do not have a detrimental effect on glycaemic control and that snacks can generally be omitted without serious hypoglycaemic problems.