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    Murakami, Kentaro and Livingstone, M. Barbara E. 2016. Associations between Meal and Snack Frequency and Diet Quality in US Adults: National Health and Nutrition Examination Survey 2003-2012. Journal of the Academy of Nutrition and Dietetics, Vol. 116, Issue. 7, p. 1101.

    Reicks, Marla Banna, Jinan Cluskey, Mary Gunther, Carolyn Hongu, Nobuko Richards, Rickelle Topham, Glade and Wong, Siew 2015. Influence of Parenting Practices on Eating Behaviors of Early Adolescents during Independent Eating Occasions: Implications for Obesity Prevention. Nutrients, Vol. 7, Issue. 10, p. 8783.


The role of eating frequency on total energy intake and diet quality in a low-income, racially diverse sample of schoolchildren

  • E Whitney Evans (a1), Paul F Jacques (a2) (a3), Gerard E Dallal (a2) (a3), Jennifer Sacheck (a2) and Aviva Must (a2) (a4)
  • DOI:
  • Published online: 29 April 2014

The relationship of meal and snacking patterns with overall dietary intake and relative weight in children is unclear. The current study was done to examine how eating, snack and meal frequencies relate to total energy intake and diet quality.


The cross-sectional associations of eating, meal and snack frequencies with total energy intake and diet quality, measured by the Healthy Eating Index 2005 (HEI-2005), were examined in separate multivariable mixed models. Differences were examined between elementary school-age participants (9–11 years) and adolescents (12–15 years).


Two non-consecutive 24 h diet recalls were collected from children attending four schools in the greater Boston area, MA, USA.


One hundred and seventy-six schoolchildren, aged 9–15 years.


Overall, 82 % of participants consumed three daily meals. Eating, meal and snack frequencies were statistically significantly and positively associated with total energy intake. Each additional reported meal and snack was associated with an 18·5 % and a 9·4 % increase in total energy intake, respectively (P<0·001). The relationships of eating, meal and snack frequencies with diet quality differed by age category. In elementary school-age participants, total eating occasions and snacks increased HEI-2005 score. In adolescents, each additional meal increased HEI-2005 score by 5·40 points (P=0·01), whereas each additional snack decreased HEI-2005 score by 2·73 points (P=0·006).


Findings suggest that snacking increases energy intake in schoolchildren. Snacking is associated with better diet quality in elementary school-age children and lower diet quality in adolescents. Further research is needed to elucidate the role of snacking in excess weight gain in children and adolescents.

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1.R Lobstein , L Baur & R Uauy (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5, Suppl. 1, 4104.

4.DS Ludwig , KE Peterson & SL Gortmaker (2001) Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 357, 505508.

5.A Must , EE Barish & LG Bandini (2009) Modifiable risk factors in relation to changes in BMI and fatness: what have we learned from prospective studies of school-aged children? Int J Obes (Lond) 33, 705715.

7.YC Wang , SN Bleich & SL Gortmaker (2008) Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988–2004. Pediatrics 121, e1604e1614.

10.B Sherry (2005) Food behaviors and other strategies to prevent and treat pediatric overweight. Int J Obes (Lond) 29, Suppl. 2, S116S126.

11.EM Taveras , CS Berkey , SL Rifas-Shiman et al. (2005) Association of consumption of fried food away from home with body mass index and diet quality in older children and adolescents. Pediatrics 116, e518e524.

12.BM Popkin & KJ Duffy (2010) Does hunger and satiety drive eating anymore? Increasing eating occasions and decreasing time between eating occasions in the United States. Am J Clin Nutr 91, 13421347.

13.C Piernas & BM Popkin (2011) Food portion patterns and trends among US children and the relationship to total eating occasion size 1977–2006. J Nutr 141, 11591164.

14.C Piernas & BM Popkin (2010) Trends in snacking among US children. Health Aff (Millwood) 29, 398404.

16.P Kaisari , M Yannakoulia & DB Panagiotakos (2013) Eating frequency and overweight and obesity in children and adolescents: a meta-analysis. Pediatrics 131, 958967.

17.N Larson & M Story (2013) A review of snacking patterns among children and adolescents: what are the implications of snacking for weight status? Child Obes 9, 104115.

20.BJ Rolls , D Engell & LL Birch (2000) Serving portion size influences 5-y-old but not 3-y-old children’s food intake. J Am Diet Assoc 100, 232234.

21.S Nielsen , A Siega-Riz & BM Popkin (2002) Trends in food locations and sources among adolescents and young adults. Prev Med 35, 107113.

22.LA Lytle , MZ Nichaman , E Obarzanek et al. (1993) Validation of 24-hour recalls assisted by food records in third-grade children. J Am Diet Assoc 93, 14311436.

23.CH Lindquist , T Cummings & MI Goran (2000) Use of tape-recorded food records in assessing children’s dietary intake. Obes Res 8, 211.

24.KW Cullen , K Watson , JH Himes et al. (2004) Evaluation of quality control procedures for 24-h dietary recalls: results from the Girls Health Enrichment Multisite Studies. Prev Med 38, Suppl., S14S23.

25.SD Baxter , WO Thompson , MS Litaker et al. (2003) Accuracy of fourth-graders’ dietary recalls of school breakfast and school lunch validated with observations: in-person versus telephone interviews. J Nutr Educ Behav 35, 124134.

26.CN Hart , HA Raynor , KM Osterholt et al. (2011) Eating and activity habits of overweight children on weekdays and weekends. Int J Pediatr Obes 6, 467472.

27.OM Thompson , C Ballew , K Resnicow et al. (2006) Dietary pattern as a predictor of change in BMI z-score among girls. Int J Pediatr Obes 30, 176182.

28.P Guenther , J Reedy & S Krebs-Smith (2008) Development of the Healthy Eating Index-2005. J Am Diet Assoc 108, 18961901.

36.J Reedy , SM Krebs-Smith (2010) Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States. J Am Diet Assoc 110, 14771484.

37.MC Nelson , D Neumark-Sztainer , PJ Hannan et al. (2009) Five-year longitudinal and secular shifts in adolescent beverage intake: findings from Project EAT (Eating Among Teens)-II. J Am Diet Assoc 109, 308312.

38.N Larson , D Neumark-Sztainer , PJ Hannan et al. (2007) Trends in adolescent fruit and vegetable consumption, 1999–2004. Am J Prev Med 32, 147150.

39.D Neumark-Sztainer , M Story , C Perry et al. (1999) Factors influencing food choices of adolescents: findings from focus-group discussions with adolescents. J Am Diet Assoc 99, 929937.

40.M Gilman , S Rifas-Shiman , L Frazier et al. (2000) Family dinner and diet quality among older children and adolescents. Arch Fam Med 9, 235240.

41.G Savige , A Macfarlane , K Ball et al. (2007) Snacking behaviors of adolescents and their association with skipping meals. Int J Behav Nutr Phys Act 4, 36.

42.JT Dwyer , M Evans , EJ Stone et al. (2001) Adolescents’ eating patterns influence their nutrient intakes. J Am Diet Assoc 101, 798802.

43.C Marmonier , D Chapelot & J Louis-Sylvestre (2000) Effects of macronutrient content and energy density of snacks consumed in a satiety state on the onset of the next meal. Appetite 34, 161168.

44.A Toschke , H Kuchenhoff , B Koletzko et al. (2005) Meal frequency and childhood obesity. Obes Res 13, 19321938.

45.J Macdiarmid , J Loe , LCA Craig et al. (2009) Meal and snacking patterns of school-aged children in Scotland. Eur J Clin Nutr 63, 12971304.

46.M Hare , D Sherrill-Mittleman , R Klesges et al. (2012) Energy underreporting in African-American girls: a longitudinal analysis. Child Obes 8, 551560.

47.CL Ogden , MD Carroll , BK Kit et al. (2012) Prevalence of obesity and trends in body mass index among US children and adolescents, 1999–2010. J Am Med Assoc 307, 483490.

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