Association of Snacking Frequency, Size, and Energy Density with Weight Status among Preschool-Aged Children in the United States.

Abstract

Snacking (ie, eating between meals) is common among US preschool-aged children, but associations with weight status are unclear. This research evaluated associations of snack frequency, size, and energy density as well as the percent of daily energy from snacking with weight status and sociodemographic characteristics among US children aged 2 to 5 years. Cross-sectional analysis of 2007-2018 National Health and Nutrition Examination Survey data using two, caregiver proxy, 24-hour dietary recalls. US children aged 2 to 5 years (n= 3,313) with at least one snack occasion over 2 days of intake. Snacking parameters included frequency (number of occasions per day), size (kilocalories per occasion), and energy density (kilocalories per gram per occasion) as well as percent of daily energy from snacking. Generalized linear regression models evaluated associations of snacking with child weight status (ie, normal weight and overweight/obesity), adjusting for survey weights, energy misreporting, mean meal size, and sociodemographic covariates. Children with overweight/obesity consumed more frequent snacks (2.8 [0.06] vs 2.5 [0.03] snacks/day, respectively; P < 0.001), larger snacks (188 [4] vs 162 [23] kcal/occasion, respectively; P < 0.001), and a greater percent of daily energy from snacking (29.80% [1.00%] vs 26.09% [0.40%], respectively; P < 0.001) than children with normal weight. Mean snack frequency and size as well as percentage of daily energy from snacking varied with child age, gender, and head of household education. Associations of snacking with child race and ethnicity were less consistent. These nationally representative findings provide evidence that the consumption of larger, more frequent snacks is associated with overweight/obesity among US children aged 2 to 5 years and snacking varies by sociodemographic characteristics.