Objective
To characterize associations of snacking frequency with weight status among US children aged 1 to 5 years.
Methods
Participants were children (n = 4,669) aged 1 to 5 years in the 2005 to ...2014 National Health and Nutrition Examination Survey (NHANES). Snacking was assessed by two 24‐hour dietary recalls using definitions that considered “snack” occasions as well as other foods/beverages consumed between meals. Overweight/obesity (OW/OB) was defined using percentile cutoffs: ≥ 97.7th weight‐for‐length (< 2 years) cutoff and the ≥ 85th BMI‐for‐age (≥ 2 years) cutoff. Linear/logistic regressions evaluated snacking based on daily occasions and relative to current recommendations (two to three snacks per day).
Results
During 2005 to 2014, US children aged 1 to 5 years consumed, on average, two to three snacks daily. Children with normal weight in both age groups tended to snack less frequently than children with OW/OB when considering all foods/beverages eaten between meals (P < 0.01‐0.12). Across most snacking definitions, children < 2 years who snacked more frequently than recommended had greater odds of having OW/OB (P < 0.01‐0.12) and consumed greater daily snack energy than those who snacked within recommendations (all P < 0.01). Recommendations did not clearly delineate weight status among children aged 2 to 5 years.
Conclusions
Snacking frequency and weight are positively associated among US children 1 to 5 years old, with most consistent associations seen among children < 2 years old and when considering all foods/beverages consumed between meals.
Snacking is nearly universal and contributes significant energy to U.S. children's diets. Little is known, however, about where and when snacking intake occurs and if such patterns change with age. ...This research evaluated age-related differences in eating location, food source location, and timing of snacking among U.S. children aged 1-19 years (y).
A cross-sectional analysis of snacking among 14,666 children in the 2007-2018 U.S. National Health and Nutrition Examination Survey was conducted using a single 24-hour dietary recall. Snacking was participant-defined and included all eating occasions outside of meals. Linear regression and analysis of covariance were used to examine the effects of age (toddler 1-2 y, preschooler 3-5 y, school-age 6-11 y, adolescent 12-19 y) on the percentage of daily snack energy consumed by eating location (at home vs. away from home), food source location (grocery store, convenience store, school/childcare, restaurant, from someone else (i.e. "socially"), and other), and time of day (morning, 6am-12pm; early afternoon, 12pm-3pm; late afternoon/afterschool 3pm-6pm; evening 6pm-9pm, late-night 9pm-12am, and overnight 12am-6am).
On average, U.S. children consumed most of their daily snacking energy at home (71%), from foods and beverages obtained from grocery stores (75%), and in the late afternoon/afterschool (31%). Toddlers and preschoolers consumed a greater percentage of their daily snack energy during the morning hours compared to school-age children and adolescents (both p < 0.001); school-age children consumed the most in the evening (27%, p < 0.001), and adolescents consumed the most in the late-night period (22%, p < 0.001). Age-related increases were seen in the percentage of daily snacking energy eaten outside the home (p < 0.001), and obtained socially (p < 0.001), from restaurants (p < 0.001), and convenience stores (p < 0.001).
Findings reveal age-related differences in eating location, food source location, and timing of snack intake among U.S. children aged 1-19 y. Younger children consume a greater percentage of snacking calories in the morning and at home relative to older children. School-age children and adolescents show greater snacking in the evening and at night and from foods obtained and eaten outside the home. Efforts to promote healthy snacking behaviors among children should consider developmental differences in snacking patterns.
Although research shows that “food parenting practices” can impact children’s diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in ...terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs – coercive control, structure, and autonomy support – as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.
► Two approaches to increasing preschool children’s vegetable liking were tested. ► Children’s vegetable liking increased similarly in repeated exposure and associative conditioning treatments. ► ...Liking ratings predicted vegetable intake, and vegetable intake more than doubled in both conditions. ► In both conditions, increases in liking were detected after six exposures to the initially-disliked vegetable. ► The increases in liking were maintained throughout the experiments.
Most young children do not meet current dietary recommendations, consuming too many energy-dense foods and too few nutrient-dense foods like vegetables. We compared two approaches to increasing children’s liking of vegetables by having them repeatedly taste small portions of vegetables that were initially not liked, presented either alone (repeated exposure; RE) or with a liked dip (associative conditioning; AC). We first conducted a between-subjects experiment, where classrooms at a childcare center were each assigned a vegetable that most children did not like, and individual children were assigned to either the RE or AC condition. A second experiment was conducted to test whether the same results would be obtained using a within-subjects design, in which each child was assigned to repeatedly taste two vegetables that were not liked, one presented with dip and one without. In both experiments, vegetable liking was assessed before, during, and after a series of eight tasting trials, and vegetable intake was measured before and after the tasting trials in Experiment 1. In both experiments, children’s vegetable liking increased from pre- to post-test, but there was no evidence of associative conditioning effects. Increases in vegetable liking, as well as intake, were similar across conditions. Although the addition of the liked dip did not augment overall effects on vegetable liking, there was some evidence that the liked dips could be used to encourage initial tasting of vegetables. In both experiments and both conditions, increases in liking were detected by the sixth exposure to the vegetable. Additional tasting trials did not produce additional increases in liking, but the increases in liking were sustained throughout the experiments. The current evidence suggests that administering few small tastes of vegetables that are initially not liked can have a lasting impact on preschool children’s liking and intake of those vegetables.
Snacks, while widely consumed in the United States (U.S.), do not have a standard definition, complicating research to understand associations, if any, with weight status. Therefore, the purpose of ...this study was to examine the association between snacking frequency and weight status using various snacking definitions that exist in the scientific literature among U.S. adults (NHANES 2013-2016; greater than or equal to20y n = 9,711). Four event-based snacking definitions were operationalized including participant-defined snacks, eating events outside of meals, and operationally defined snacks based on absolute thresholds of energy consumed (>50 kcal). Weight status was examined using body mass index (BMI), waist circumference, and sagittal abdominal diameter risk. Logistic regression models examined snacking frequency and associations with weight status. Outcomes varied by the definition of a snack employed, but the majority of findings were null. Mean energy from snacks was significantly higher among women with obesity compared to women with normal weight when a snack was defined as any event outside of a typical mealtime (i.e. other than breakfast, lunch, dinner, super, brunch), regardless of whether or not it contributed greater than or equal to50 kcal. Further investigation into ingestive behaviors that may influence the relationship between snacking frequency and weight status is needed.
BACKGROUND: Large portions of energy-dense foods are one feature of obesity-promoting dietary environments. Entrée portion size has been shown to influence energy intake at meals by young children. ...The role of energy density (ED) in children's response to portion size, however, is unknown. OBJECTIVE: We aimed to test the effects of portion size and ED on children's food and energy intakes at a meal. DESIGN: Participants were 53 (28 girls and 25 boys; 15 Hispanic, 20 black, 16 white, 2 other race) 5- to 6-y-old children mean (±SD) body mass index percentile: = 61 ± 28. A 2 x 2 within-subjects design was used to manipulate entrée portion size (250 compared with 500 g) and ED (1.3 compared with 1.8 kcal/g). Fixed portions of other familiar foods were provided. Weighed intake, food preference, and weight and height data were obtained. RESULTS: Effects of portion size (P < 0.0001) and ED (P < 0.0001) on entrée energy intake were independent but additive. Energy intake from other foods at the meal did not vary across conditions. Compared with the reference portion size and ED condition, children consumed 76% more energy from the entrée and 34% more energy at the meal when served the larger, more energy-dense entrée. Effects did not vary by sex, age, entrée preference, or body mass index z score. CONCLUSIONS: These findings provide new evidence that portion size and ED act additively to promote energy intake at meals among preschool-aged children.
The home environment is a central and modifiable influence on the development of childhood obesity. Evidence supports the central role of parents in shaping problematic child eating behaviors and ...excess weight. Most studies of feeding emphasize parent-driven influences without taking into account the child's role in eating interactions. Few studies have addressed the bi-directional nature of feeding dynamics in studies of young children.
The goals of this study were: 1) to examine if parental feeding styles during preschool (4-5 years) predict child weight status at 7-9 years, and 2) to examine the direction of effects between parental feeding styles and child weight status over time. Participants were part of a larger longitudinal study of Hispanic Head Start families living in the West South Central United States. Data from mother/child dyads were collected at three time points: Time 1 (ages 4-5), Time 2 (ages 5 ½-6 ½), and at Time 3 (ages 7-9). Only data from the Times 1 and 3 were used in the current analyses. A total of 128 mothers and their children had data on all variables needed for the analyses. Assessments included parent-reported feeding styles, feeding practices, acculturation, child eating behaviors, and child height and weight. Hierarchical regression was used to examine the first aim; a cross-lagged panel analysis examined the second aim.
An indulgent parental feeding style at ages 4-5 was associated with increased child BMI z-score at ages 7-9. Indulgent feeding significantly contributed to child BMI z-score beyond demographics, baseline child BMI z-score, parental acculturation, and child eating behaviors. Regarding the direction of effects in parental feeding interactions, the cross-lagged analyses showed that both indulgent feeding style and authoritative feeding style at Time 1 positively predicted child BMI z-scores at Time 3. Child effects were significant as well. Child BMI z-score at Time 1 positively predicted indulgent feeding and negatively predicted authoritarian feeding at Time 3.
Indulgent feeding should be addressed in future family-focused childhood obesity initiatives focused on young children and their parents.
Summary
Parents play a critical role in the development of children's eating behaviours and weight status, serving as providers, models and regulators of the food environment. Many research reviews ...have focused on the robust body of evidence on coercive control in feeding: how parenting practices such as restriction and pressure to eat increase children's risk for developing undesirable eating behaviours and unhealthy weight outcomes. Fewer reviews adopt a strengths‐based perspective focusing on the ways that parents can actively support the development of healthy eating behaviours and weight trajectories. Emerging research on such positive parenting styles and practices offers solutions beyond the avoidance of coercive control, as well as opportunities to highlight parallels between research on food parenting and the broader, well‐established developmental literature on positive parenting. The focus of this review is to summarize what is known regarding benefits of positive parenting styles and practices for child eating and weight outcomes and discuss recommendations for future research. Current evidence supports starting with responsive feeding and parenting during infancy and incorporating structure and limit setting in early childhood, with monitoring and mealtime structure remaining important during middle childhood and adolescence. Areas for future research include: (1) further examination of the implications of identified food parenting practices and styles among diverse groups and caregivers; (2) increased consideration of child factors (eg, temperament) as moderators or mediators; and (3) further clarification of the relationship between general parenting and food parenting.
Behavioral mechanisms that contribute to the association between breastfeeding and reduced obesity risk are poorly understood. The purpose of this study was to evaluate the hypothesis that feeding ...human milk from the breast (direct breastfeeding) has a more optimal association with subsequent child appetite regulation behaviors and growth, when compared to bottle-feeding.
Children (n = 109) aged 3- to 6- years were retrospectively classified as directly breastfed (fed exclusively at the breast), bottle-fed human milk, or bottle-fed formula in the first three months of life. Young children's appetite regulation was examined by measuring three constructs (satiety response, food responsiveness, enjoyment of food) associated with obesity risk, using the Child Eating Behavior Questionnaire. Multinomial logistic regression analyses were used to test whether children bottle-fed either human milk or formula had reduced odds of high satiety and increased odds of high food responsiveness and high enjoyment of food compared to children fed directly from the breast. Current child weight status and growth trends from 6-36 months were also examined for their relation to direct breastfeeding and appetite regulation behaviors in early childhood.
Children fed human milk in a bottle were 67% less likely to have high satiety responsiveness compared to directly breastfed children, after controlling for child age, child weight status, maternal race/ethnicity, and maternal education. There was no association of bottle-feeding (either human milk or formula) with young children's food responsiveness and enjoyment of food. There was neither an association of direct breastfeeding with current child weight status, nor was there a clear difference between directly breastfed and bottle-fed children in growth trajectories from 6- to 36-months. More rapid infant changes in weight-for-age score were associated with lower satiety responsiveness, higher food responsiveness and higher enjoyment of food in later childhood
While direct breastfeeding was not found to differentially affect growth trajectories from infancy to childhood compared to bottle-feeding, results suggest direct breastfeeding during early infancy is associated with greater appetite regulation later in childhood. A better understanding of such behavioral distinctions between direct breastfeeding and bottle-feeding may identify new pathways to reduce the pediatric obesity epidemic.
•Narrative review on how parents influence children's dietary behavior.•We propose a new model of the relation between parenting and child dietary behavior.•Parental dietary behavior and food ...parenting practices are interactive sources.•Parental effects are most importantly mediated by the home food environment.•Studies testing our model may inform effective parent–child overweight interventions.
Until now, the literatures on the effects of food parenting practices and parents' own dietary behavior on children's dietary behavior have largely been independent from one another. Integrating findings across these areas could provide insight on simultaneous and interacting influences on children's food intake. In this narrative review, we provide a conceptual model that bridges the gap between both literatures and consists of three main hypotheses. First, parental dietary behavior and food parenting practices are important interactive sources of influence on children's dietary behavior and Body Mass Index (BMI). Second, parental influences are importantly mediated by changes in the child's home food environment. Third, parenting context (i.e., parenting styles and differential parental treatment) moderates effects of food parenting practices, whereas child characteristics (i.e., temperament and appetitive traits) mainly moderate effects of the home food environment. Future studies testing (parts of) this conceptual model are needed to inform effective parent–child overweight preventive interventions.
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