Eating Frequency Research Articles

Children's psychosocial stress and emotional eating: A role for leptin?

Psychosocial stress can be a health threat by stimulating unhealthier eating behaviors. We aim to test the role of the hormone leptin in the association between stress and diet/emotional eating as detected in primary school children. In a two-wave longitudinal study with 308 Belgian children (5-12y) in 2010-2012, the association of fasting serum leptin with reported stress (negative events and emotional problems), measured stress by salivary cortisol (overall cortisol output and awakening response), emotional eating and food consumption frequency was examined. Analyses were split by sex. Mediation and moderation by leptin change were tested. One stress marker (overall cortisol output) was significantly correlated with high leptin levels, but only in girls and cross-sectionally. Only in boys, leptin was associated with low emotional eating. Leptin was not a significant predictor of unhealthy food consumption. Leptin change was not a mediator but an enhancing moderator in the link between stress (high cortisol output and emotional problems) and emotional eating in girls: high reports of emotional eating in 2012 were present in the case of combined high 2-year leptin increase and high stress at baseline. Stress (represented by emotional problems and high daily cortisol) seems to lead to hyperleptinemia in girls; and the combination of high stress and hyperleptinemia might make girls more vulnerable to stress-induced eating. No functional data on leptin sensitivity were present, but results might suggest that stress induces lower sensitivity to the anorexigenic leptin activity. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:471-480).

Analyses of the role of the glucocorticoid receptor gene polymorphism (rs41423247) as a potential moderator in the association between childhood overweight, psychopathology, and clinical outcomes in Eating Disorders patients: A 6 years follow up study

Childhood overweight and the SNP rs41423247 of the glucocorticoid receptor gene (GR) were reported to represent predisposing factors for Eating Disorders (EDs). The distribution of the polymorphism was evaluated in 202 EDs patients, and in 116 healthy subjects. The Structured Clinical Interview for the DSM-IV and self-reported questionnaires were administered at the admission to the clinic and at 3 time points (end of a cognitive behavioral therapy, 3 and 6 years follow up). G-allele was associated with childhood overweight, depressive disorder comorbidity, and diagnostic instability. G-allele carriers reporting childhood overweight showed greater frequency of subjective binge eating and emotional eating.

Association between depression and eating behaviors among bariatric surgery candidates in a Turkish sample.

The purpose of this study was to explore further whether depression is associated with problematic eating behaviors in a sample of Turkish bariatric surgery candidates. This descriptive study included 168 consecutively seen bariatric surgery candidates in a university bariatric surgery outpatient. Participants were asked to complete the Dutch Eating Behavior Questionnaire (DEBQ), the Beck Depression Inventory (BDI) and surveys assessing sociodemographic and clinical variables. Correlations and linear regression analyses were performed to evaluate the relationship between clinical and demographic variables. Participants had a mean age 37.7±11.3years and BMI of 46.4±6.7kg/m2 (SD=6.7). According to BDI scores, 75.5% of the patients had mild, moderate, or severe depressive symptomatology. Lower levels of depressive symptoms were associated with higher levels of restrictive eating (r=-0.17; p=0.04), whereas higher levels of depressive symptoms were associated with more frequent eating in response to both internal (r=0.3; p=0.002) and external (r=0.2; p=0.04) cues. The BDI scores were significantly associated with increased external eating (ß=0.03, p<0.02) and emotional eating (ß=0.03, p<0.002) scores. BMI (β=-0.02, p=0.02>0.1) was not associated with DEBQ total scores. This research suggests that mild, moderate or severe depressive symptoms are observed in most of the bariatric surgical candidate patients. There is a positive correlation between severity of depression and emotional/external eating behaviors, and a negative correlation between severity of depression and restrictive eating behavior. Additional research is needed to determine whether treating depression preoperatively can assist with alleviating problematic eating behaviors.

A preliminary mechanistic test of the effects of light therapy in bulimia nervosa

ABSTRACTNegative affect is an important antecedent of binge eating episodes in bulimia nervosa (BN). A small number of studies have found that bright light therapy (BLT) decreases negative affect and binge eating frequency in BN. This study tested whether decreases in the frequency of binge eating in BN during BLT are accounted for by changes in negative affect. Participants (N = 9) with BN participated in a 6-week within-subjects trial of BLT, making daily ratings of the occurrence of eating disorder behaviours and negative affect, and resulting in 242 participant-days of data. They also completed an assessment battery on four occasions: baseline, pre-intervention, post-intervention, and 2-week follow-up. Use of the therapy light was associated with decreased likelihood of binge eating and lower negative affect; however, the likelihood of binge eating was not entirely accounted for by changes in negative affect. Future research should continue to investigate possible mechanisms through which BLT may infl...

Increased Eating Frequency Is Associated with Lower Obesity Risk, But Higher Energy Intake in Adults: A Meta-Analysis.

Body weight is regulated by energy intake which occurs several times a day in humans. In this meta-analysis, we evaluated whether eating frequency (EF) is associated with obesity risk and energy intake in adults without any dietary restriction. Experimental and observational studies published before July 2015 were selected through English-language literature searches in several databases. These studies reported the association between EF and obesity risk (odd ratios, ORs) in adults who were not in dietary restriction. R software was used to perform statistical analyses. Ten cross-sectional studies, consisting of 65,742 participants, were included in this analysis. ORs were considered as effect size for the analysis about the effect of EF on obesity risk. Results showed that the increase of EF was associated with 0.83 time lower odds of obesity (i.e., OR = 0.83, 95% confidence intervals (CI) 0.70–0.99, p = 0.040). Analysis about the effect of EF on differences in participants’ energy intake revealed that increased EF was associated with higher energy intake (β = 125.36, 95% CI 21.76–228.97, p = 0.017). We conclude that increased EF may lead to lower obesity risk but higher energy intake. Clinical trials are warranted to confirm these results and to assess the clinical practice applicability.

Heated hatha yoga to target cortisol reactivity to stress and affective eating in women at risk for obesity-related illnesses: A randomized controlled trial.

Cortisol reactivity to stress is associated with affective eating, an important behavioral risk factor for obesity and related metabolic diseases. Yoga practice is related to decreases in stress and cortisol levels, thus emerging as a potential targeted complementary intervention for affective eating. This randomized controlled trial examined the efficacy of a heated, hatha yoga intervention for reducing cortisol reactivity to stress and affective eating. Females (N = 52; ages 25-46 years; 75% White) at risk for obesity and related illnesses were randomly assigned to 8 weeks of Bikram Yoga practice or to waitlist control. Cortisol reactivity to a laboratory stress induction were measured at Weeks 0 (pretreatment) and 9 (posttreatment). Self-reported binge eating frequency and coping motives for eating were assessed at Weeks 0, 3, 6, and 9. Among participants with elevated cortisol reactivity at pretreatment ("high reactors"), those randomized to the yoga condition evidenced greater pre- to posttreatment reductions in cortisol reactivity (p = .042, d = .85), but there were not significant condition differences for the "low reactors" (p = .178, d = .53). Yoga participants reported greater decreases in binge eating frequency (p = .040, d = .62) and eating to cope with negative affect (p = .038, d = .54). This study provides preliminary support for the efficacy of heated hatha yoga for treating physiological stress reactivity and affective eating among women at risk for obesity-related illnesses. (PsycINFO Database Record

Associations between Restrained Eating and the Size and Frequency of Overall Intake, Meal, Snack and Drink Occasions in the UK Adult National Diet and Nutrition Survey.

Obesity is a global public health priority. Restrained eating is related to obesity and total energy intake but associations with the eating patterns are unclear. We examined the associations of restrained eating with the size and frequency of intake occasions among 1213 British adult (19–64 y) participants in a cross-sectional analysis of the UK National Diet and Nutrition Survey 2000. The Dutch Eating Behaviour Questionnaire assessed restrained eating. Overall intake occasions were all energy consumed in a 60 min period. A food-based classification separated intake occasions into meals, snacks, or drinks from seven-day weighed food diaries. Average daily frequency and size (kcal) of overall intake, meal, snack and drink occasions were calculated and associations with restrained eating were modelled using multiple linear regression including under-reporting of energy intake, age, gender, BMI, emotional eating, external eating and physical activity as covariates. Restrained eating was very weakly positively correlated with overall intake (r = 0.08, p<0.05) and meal frequency (r = 0.10, p<0.05) but not snack or drink frequency (r = 0.02 and -0.02 respectively). Adjusted regressions showed a one-point change in restrained eating was associated with 0.07 (95% CI 0.03, 0.11) more meal occasions/day and 0.13 (95% CI 0.01, 0.25) extra overall intake occasions/day. Overall intake occasion size was weakly negatively correlated with restrained eating regardless of type (r = -0.16 to -0.20, all p<0.0001). Adjusted regressions showed each one-point increase in restrained eating was associated with lower-energy meals (-15 kcal 95% CI -5.9, -24.2) and drinks (-4 kcal 95%CI -0.1, -8), but not snacks or overall intake occasions. Among a national sample of UK adults, greater restrained eating was associated with smaller and slightly more frequent eating, suggesting that restrained eaters restrict their energy intake by reducing meal/drink size rather than skipping snacks.

Does impulsivity predict outcome in treatment for binge eating disorder? A multimodal investigation

Multiple dimensions of impulsivity (e.g., affect-driven impulsivity, impulsive inhibition – both general and food-specific, and impulsive decision-making) are associated with binge eating pathology cross-sectionally, yet the literature on whether impulsivity predicts treatment outcome is limited. The present pilot study explored impulsivity-related predictors of 20-week outcome in a small open trial (n = 17) of a novel treatment for binge eating disorder. Overall, dimensions of impulsivity related to emotions (i.e., negative urgency) and food cues emerged as predictors of treatment outcomes (i.e., binge eating frequency and global eating pathology as measured by the Eating Disorders Examination), while more general measures of impulsivity were statistically unrelated to global eating pathology or binge frequency. Specifically, those with higher levels of negative urgency at baseline experienced slower and less pronounced benefit from treatment, and those with higher food-specific impulsivity had more severe global eating pathology at baseline that was consistent at post-treatment and follow-up. These preliminary findings suggest that patients high in negative urgency and with poor response inhibition to food cues may benefit from augmentation of existing treatments to achieve optimal outcomes. Future research will benefit from replication with a larger sample, parsing out the role of different dimensions of impulsivity in treatment outcome for eating disorders, and identifying how treatment can be improved to accommodate higher levels of baseline impulsivity.

Effects of transcranial direct current stimulation (tDCS) on binge eating disorder.

To investigate the effect of transcranial direct current stimulation (tDCS) on food craving, intake, binge eating desire, and binge eating frequency in individuals with binge eating disorder (BED). N = 30 adults with BED or subthreshold BED received a 20-min 2 milliampere (mA) session of tDCS targeting the dorsolateral prefrontal cortex (DLPFC; anode right/cathode left) and a sham session. Food image ratings assessed food craving, a laboratory eating test assessed food intake, and an electronic diary recorded binge variables. tDCS versus sham decreased craving for sweets, savory proteins, and an all-foods category, with strongest reductions in men (p < 0.05). tDCS also decreased total and preferred food intake by 11 and 17.5%, regardless of sex (p < 0.05), and reduced desire to binge eat in men on the day of real tDCS administration (p < 0.05). The reductions in craving and food intake were predicted by eating less frequently for reward motives, and greater intent to restrict calories, respectively. This proof of concept study is the first to find ameliorating effects of tDCS in BED. Stimulation of the right DLPFC suggests that enhanced cognitive control and/or decreased need for reward may be possible functional mechanisms. The results support investigation of repeated tDCS as a safe and noninvasive treatment adjunct for BED. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:930-936).

Neurofeedback Against Binge Eating: A Randomized Controlled Trial in a Female Subclinical Threshold Sample.

Brain-directed treatment techniques, such as neurofeedback, have recently been proposed as adjuncts in the treatment of eating disorders to improve therapeutic outcomes. In line with this recommendation, a cue exposure EEG-neurofeedback protocol was developed. The present study aimed at the evaluation of the specific efficacy of neurofeedback to reduce subjective binge eating in a female subthreshold sample. A total of 75 subjects were randomized to EEG-neurofeedback, mental imagery with a comparable treatment set-up or a waitlist group. At post-treatment, only EEG-neurofeedback led to a reduced frequency of binge eating (p = .015, g = 0.65). The effects remained stable to a 3-month follow-up. EEG-neurofeedback further showed particular beneficial effects on perceived stress and dietary self-efficacy. Differences in outcomes did not arise from divergent treatment expectations. Because EEG-neurofeedback showed a specific efficacy, it may be a promising brain-directed approach that should be tested as a treatment adjunct in clinical groups with binge eating. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA

To investigate associations between eating frequency and energy intake, energy density, diet quality and body weight status in adults from the USA, combined data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Survey (NHANES) were used in this study. The first 24-h dietary recall data from eligible participants (4017 men and 3774 women) were used to calculate eating frequency, as well as energy intake, energy density and the Healthy Eating Index 2010 (HEI-2010), as a measure of diet quality. BMI and waist circumference were obtained from the NHANES body measures data. Adjusting for confounding socio-demographic characteristics and lifestyle factors, a higher eating frequency was significantly associated with higher energy intake in both men and women (both P<0·001). A higher eating frequency was also significantly associated with lower energy density in both men and women, regardless of whether beverage or water intake was included in the calculation of energy density (all P<0·01). Moreover, there was a significant positive association between eating frequency and the HEI-2010 total score in both men and women (both P<0·001). Eating frequency was inversely associated with BMI in women (P=0·003), as well as waist circumference in both men (P=0·032) and women (P=0·010). Results from the present study suggested that adults with a higher eating frequency in the USA had a healthier diet with lower energy density and better diet quality, and eating frequency was inversely associated with body weight status.

Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy

Cognitive-behavioural therapy (CBT) is the recommended treatment for binge eating, yet many individuals do not recover, and innovative new treatments have been called for. The current study compares traditional CBT with two augmented versions of CBT; schema therapy, which focuses on early life experiences as pivotal in the history of the eating disorder; and appetite-focused CBT, which emphasises the role of recognising and responding to appetite in binge eating. 112 women with transdiagnostic DSM-IV binge eating were randomized to the three therapies. Therapy consisted of weekly sessions for six months, followed by monthly sessions for six months. Primary outcome was the frequency of binge eating. Secondary and tertiary outcomes were other behavioural and psychological aspects of the eating disorder, and other areas of functioning. No differences among the three therapy groups were found on primary or other outcomes. Across groups, large effect sizes were found for improvement in binge eating, other eating disorder symptoms and overall functioning. Schema therapy and appetite-focused CBT are likely to be suitable alternative treatments to traditional CBT for binge eating.

Emotion Regulation and Loss of Control Eating in Community-Based Adolescents.

The current study investigated concurrent and prospective associations between emotion-related constructs and loss of control (LOC) eating in adolescents. Community-based females (N = 588) completed annual self-report assessments of LOC eating, emotional awareness, emotion regulation strategies, and neuroticism from ages 16 to 18years. Linear regressions and a regression-based multiple mediation model using bootstrapping were computed to examine the relationships among emotion-related constructs and LOC eating frequency. In the concurrent model, age 18 emotional awareness and emotion regulation strategies were associated with age 18 LOC eating, F(6, 416) = 12.11, p < 0.001, accounting for 4.5% of the variance after controlling for demographics, body mass index, and neuroticism, F change = 10.81, p < 0.001. In the prospective model, age 17 emotional awareness predicted age 18 LOC eating, F(7, 425) = 11.67, p < 0.001, accounting for 1.7% of unique variance beyond the effects of age 16 LOC eating and age 17 demographics, body mass index, and neuroticism, F change = 4.26, p = 0.015. In the multiple mediation model, age 18 emotion regulation strategies mediated the association between age 17 neuroticism and age 18 LOC eating, indirect effect estimate = 0.003, 95% confidence interval = 0.001-0.005, after controlling for age 16 LOC eating and age 17 demographics, body mass index, and emotion regulation variables. Results suggest that deficient emotion regulation may contribute to the onset and maintenance of LOC eating in adolescence (although effects were small), and may partially explain the well-established prospective relationship between negative emotionality and later LOC eating. Prevention and early intervention programs should seek to improve adaptive coping in at-risk populations.

Eating, feeling, and feeding: Does maternal binge eating predict use of child feeding practices through emotional responsiveness?

Eating, feeling, and feeding: Does maternal binge eating predict use of child feeding practices through emotional responsiveness?

Associations between meal and snack frequency and overweight and abdominal obesity in US children and adolescents from National Health and Nutrition Examination Survey (NHANES) 2003-2012.

The association between eating frequency (EF) and adiposity in young populations is inconsistent. This cross-sectional study examined associations of EF, meal frequency (MF) and snack frequency (SF) with adiposity measures in US children aged 6-11 years (n 4346) and adolescents aged 12-19 years (n 6338) participating in the National Health and Nutrition Examination Survey 2003-2012. Using data from two 24-h dietary recalls, all eating occasions providing ≥210 kJ of energy were divided into meals or snacks based on contribution to energy intake (≥15 or <15 %), self-report and time (06.00-09.00, 12.00-14.00 and 17.00-20.00 hours or others). When analysed without adjustment for the ratio of reported energy intake:estimated energy requirement (EI:EER), all measures of EF, MF and SF showed inverse or null associations with overweight (BMI≥85th percentile of BMI-for-age) and abdominal obesity (waist circumference≥90th percentile) in both children and adolescents. After adjustment for EI:EER, however, EF and SF, but not MF, showed positive associations in children, irrespective of the definition of meals and snacks. In adolescents, after adjustment for EI:EER, positive associations were observed for EF (abdominal obesity only), SF based on energy contribution and MF based on self-report, whereas there was an inverse association between MF based on energy contribution and overweight. In conclusion, higher SF and EF, but not MF, were associated with higher risks of overweight and abdominal obesity in children, whereas associations varied in adolescents, depending on the definition of meals and snacks. Prospective studies are needed to establish the associations observed here.

Future of sustainable eating? Examining the potential for expanding bean eating in a meat-eating culture

A transition towards more sustainable food consumption requires changes in everyday eating patterns, particularly a substitution of animal protein with plant-based protein sources. However, in many European countries plant protein consumption is low compared to meat consumption. The article explores plant protein consumption frequencies, future intentions to increase bean consumption, and the associations of frequent bean eating with socioeconomic factors and bean-related meanings, material issues and competence. A population web-based survey was conducted in 2013 among 15–64-year-old Finns (n=1048). The results showed that beans and soy-based plant proteins were infrequently consumed. A fifth of the respondents intended to increase their bean consumption in the future, intention being the greatest among those who already included beans in their diets. Frequent bean consumption was most likely among persons aged 25–34, living around the capital district, with education higher than comprehensive or vocational school, and who were vegetarian. Perceiving beans as culturally acceptable and good-tasting, and having competence in preparing bean meals were positively associated with the frequent eating of beans. The results suggest that for plant proteins to replace meat, new meanings and competences related to preparing and eating pulse-based dishes are needed. Based on our results, we build alternative future scenarios for plant protein consumption and the related requirements for changes. Several actor groups, such as NGOs, politicians, celebrity chefs and teachers of home economics have a central role in the developments.

Association of eating frequency with anthropometric indices and blood pressure in children and adolescents: the CASPIAN‐IV Study

ObjectivesThis study was conducted to explore the association of eating frequency (EF) with anthropometric indices and blood pressure (BP) in children and adolescents. MethodsThis nationwide cross‐sectional study was performed on a multi‐stage sample of 14,880 students, aged 6–18 years, living in 30 provinces in Iran. Parents were asked to report dietary intake of children as frequency of food groups and/or items. EF was defined as the sum of the daily consumption frequency of main meals and snacks. Association of EF with weight disorders, abdominal obesity, and elevated BP was assessed using different logistic regression models adjusted for potential confounding factors. ResultsEating more frequently (≥6 vs. ≤3) was found among students who were at younger age (11.91 vs. 13.29 years) (p<0.001). Students who reported an EF of 4 (OR: 0.67, CI: 0.57–0.79), 5 (OR: 0.74, CI: 0.62–0.87), and 6 (OR: 0.54, CI: 0.44–0.65) had lower odds of being obese compared to those who had EF≤3. Having EF of 4 (OR: 0.82, CI: 0.71–0.94), 5 (OR: 0.86, CI: 0.74–0.99), and ≥6 (OR: 0.73, CI: 0.63–0.85) was related to lower prevalence of abdominal adiposity. ConclusionHigher EF was associated with lower mean values of anthropometric and BP measures, as well as with lower prevalence of generalized and abdominal obesity in children and adolescents. Longitudinal studies are needed to assess the long‐term effects of EF on body composition in the pediatric age group.

Eating frequency predicts new onset hypertension and the rate of progression of blood pressure, arterial stiffness, and wave reflections.

Cross-sectional evidence indicates that eating frequency correlates with blood pressure, hypertension, and related target organ damage. The aim of the present study was to prospectively assess eating frequency as a predictor of arteriosclerosis progression and new onset hypertension over a follow-up period of 5 years in adults without cardiovascular disease. Eating frequency among other dietary parameters was evaluated in 115 nondiabetic study participants from a general population sample (54 ± 9.1 years, 45 women) at a baseline visit. Metabolic parameters known to be associated with eating frequency, markers of arteriosclerosis, including augmentation index, pulse wave velocity, SBP, and DBP were evaluated in all volunteers at baseline and after a 5-year follow-up. By applying linear mixed models analysis, it was found that a high eating frequency at baseline significantly correlated with the rate of progression of pulse wave velocity (β = 0.521, P = 0.004), augmentation index (β = 0.503, P = 0.01), SBP (β = 0.694, P < 0.001), and DBP (β = 0.477, P = 0.009) and the incidence of new onset hypertension (odds ratio = 8.89, P < 0.001). After adjustment traditional cardiovascular risk factors, heart rate, homeostasis model assessment index of insulin resistance and total energy intake, the associations with augmentation index, SBP, DBP, and new onset hypertension remained significant. In a population of nondiabetic adults without cardiovascular disease, eating frequency is associated with the rate of progression of wave reflections, blood pressure and of new onset hypertension. Interventional studies should confirm these data and possibly further assess the utility of eating behavior in the prevention of new onset hypertension and related target organ damage.

Randomized controlled trial testing behavioral weight loss versus multi-modal stepped-care treatment for binge eating disorder

IntroductionBinge eating disorder (BED) is prevalent, associated with obesity and elevated psychiatric co-morbidity, and represents a treatment challenge.Objective and aimsA controlled comparison of multi-modal, stepped-care versus behavioral-weight-loss (BWL) for BED.MethodsOne hundred and ninety-one patients (71% female, 79% white) with BED and co-morbid obesity (mean BMI 39) were randomly assigned to 6 months of BWL (n = 39) or stepped-care (n = 152). Within stepped-care, patients started BWL for one month; treatment-responders continued BWL while non-responders switched to cognitive-behavioral-therapy (CBT) and all stepped-care patients were additionally randomized to anti-obesity medication or placebo (double-blind) for five months. Independent assessments were performed by research-clinicians at baseline, throughout treatment, and post-treatment (90% assessed) with reliably-administered structured interviews.ResultsIntent-to-treat analyses of remission rates (0 binges/month) revealed BWL and stepped-care did not differ significantly overall (74% vs 64%); within stepped-care, remission rates differed (range 40% - 79%) with medication significantly superior to placebo (P &lt; 0.005) and among initial non-responders switched to CBT (P &lt; 0.002). Mixed-models analyses of binge eating frequency revealed significant time effects but BWL and stepped-care did not differ overall; within stepped-care, medication was significantly superior to placebo overall and among initial non-responders switched to CBT. Mixed models revealed significant weight-loss but BWL and stepped-care did not differ overall; within stepped-care, medication was significantly superior to placebo overall and among both initial responders continued on BWL and non-responders switched to CBT.ConclusionsOverall, BWL and stepped-care treatments produced improvements in binge-eating and weight loss in obese BED patients. Anti-obesity medication enhanced outcomes within a stepped-care model.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Associations between Meal and Snack Frequency and Diet Quality in US Adults: National Health and Nutrition Examination Survey 2003-2012

BackgroundThe associations between eating frequency and diet quality are inconclusive, which might be a result of different effects of meal frequency and snack frequency. ObjectiveThis cross-sectional study examined the associations of eating frequency, meal frequency, and snack frequency with diet quality, based on data from the National Health and Nutrition Examination Survey 2003-2012. DesignDietary intake was assessed in 19,427 US adults aged 20 years or older, using two 24-hour dietary recalls. All eating occasions providing ≥50 kcal were divided into either meals or snacks on the basis of contribution to daily energy intake (≥15% or <15%), self-report, and time (6 am to 10 am, 12 pm to 3 pm, and 6 pm 9 pm or others). Diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010). Statistical analyses performedLinear regression analyses were performed to explore the associations of eating frequency, meal frequency, and snack frequency (independent variables) with dietary intake variables (dependent variables). ResultsHigher eating frequency was modestly and positively associated with higher HEI-2010 in both men and women; one additional eating occasion per day increased HEI-2010 by 1.77 points in men and 2.22 points in women (both P<0.0001). All measures of meal frequency and snack frequency were also modestly and positively associated with HEI-2010 in both sexes, irrespective of the definition of meals and snacks. However, the associations were stronger for meal frequency than for snack frequency; one additional meal per day increased HEI-2010 by 2.14 to 5.35 points, and one additional snack per day increased HEI-2010 by 1.25 to 1.97 points (all P<0.0001). ConclusionsIn a representative sample of US adults, both meal frequency and snack frequency were modestly associated with better diet quality.