Abstract
To evaluate the association of snacking between main meals with the risk of developing metabolic syndrome. A dynamic prospective cohort study (the SUN Project; Seguimiento Universidad de Navarra). Snack consumption was evaluated using the question: 'Do you have the habit of snacking between main meals?' Metabolic syndrome was defined according to the updated harmonizing criteria. We estimated multivariable-adjusted relative risks (RR) of metabolic syndrome and their 95 % confidence intervals using Poisson regression models. An exploratory factor analysis was also used to identify patterns of snacking. University of Navarra, Spain. The study included 6851 university graduates, initially free of metabolic syndrome, and followed-up them for a median of 8·3 years. Among our participants, 34·6% reported usual snacking between main meals. The cumulative incidence of metabolic syndrome was 5·1 % (9·5% among men and 2·8% among women). Snacking between main meals was significantly associated with higher risk for developing metabolic syndrome after multivariable adjustment (RR=1·44; 95%CI 1·18, 1·77). Higher adherence to an 'unhealthy snacking pattern' was also independently associated with increased incidence of metabolic syndrome (fourth quartile of adherence compared with non-snacking: RR=1·68; 95% CI 1·23, 2·29; P for trend <0·001). Our findings suggest that avoidance of snacking between main meals can be included among the preventive approaches to reduce the risk of metabolic syndrome development, especially when snacks contain foods of poor nutritional quality.
Highlights
Exposure assessment: snacking between main meals We evaluated usual snack consumption using the following question included in the baseline questionnaire (Q_0): ‘Do you have the habit of snacking between main meals?’ The participants were classified into two categories according to their yes or no response
As a consequence of this cultural norm, when we evaluated the meaning of the between-meal snacking question among a sub-sample of the cohort (n 53), 85 % of them considered snacking as an unstructured eating event
Compared with those who did not snack between main meals, participants with this eating habit were more likely to be younger, women, single and have lower years of university education
Summary
Design The SUN Project (Seguimiento Universidad de Navarra; University of Navarra Follow-up) is a dynamic prospective cohort study with permanently open recruitment, conducted in Spain among university graduates since December 1999. Instead of a single (most likely) value, twenty values were sampled from an estimated uniform distribution ( taking into account baseline values of sex, age, educational level, marital status, smoking status, alcohol consumption, physical activity, total energy intake, Mediterranean diet adherence and baseline BMI as predictors of the missing value) We imputed their values to 4899 participants who had missing values in HDL-cholesterol and/or TAG and/or time watching television, adding a random term. The number of missing values that were imputed with multiple imputations at baseline was
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