Energy-dense Snack Foods Research Articles

The Importance of a Multi-Dimensional Approach for Studying the Links between Food Access and Consumption1–3

Research on neighborhood food access has focused on documenting disparities in the food environment and on assessing the links between the environment and consumption. Relatively few studies have combined in-store food availability measures with geographic mapping of stores. We review research that has used these multi-dimensional measures of access to explore the links between the neighborhood food environment and consumption or weight status. Early research in California found correlations between red meat, reduced-fat milk, and whole-grain bread consumption and shelf space availability of these products in area stores. Subsequent research in New York confirmed the low-fat milk findings. Recent research in Baltimore has used more sophisticated diet assessment tools and store-based instruments, along with controls for individual characteristics, to show that low availability of healthy food in area stores is associated with low-quality diets of area residents. Our research in southeastern Louisiana has shown that shelf space availability of energy-dense snack foods is positively associated with BMI after controlling for individual socioeconomic characteristics. Most of this research is based on cross-sectional studies. To assess the direction of causality, future research testing the effects of interventions is needed. We suggest that multi-dimensional measures of the neighborhood food environment are important to understanding these links between access and consumption. They provide a more nuanced assessment of the food environment. Moreover, given the typical duration of research project cycles, changes to in-store environments may be more feasible than changes to the overall mix of retail outlets in communities.

The Ubiquity of Energy-Dense Snack Foods: A National Multicity Study

We assessed the availability and accessibility of energy-dense snacks in retail stores whose primary merchandise was not food and whether these varied by store type, region, or socioeconomic factors. We conducted systematic observations of 1082 retail stores in 19 US cities and determined the availability and accessibility of 6 categories of energy-dense snack foods. Snack food was available in 41% of the stores; the most common forms were candy (33%), sweetened beverages (20%), and salty snacks (17%). These foods were often within arm's reach of the cash register queue. We observed snack foods in 96% of pharmacies, 94% of gasoline stations, 22% of furniture stores, 16% of apparel stores, and 29% to 65% of other types of stores. Availability varied somewhat by region but not by the racial or socioeconomic characteristics of nearby census tracts. Energy-dense snack foods and beverages, implicated as contributors to the obesity epidemic, are widely available in retail stores whose primary business is not food. The ubiquity of these products may contribute to excess energy consumption in the United States.

Neighborhood Food Environments and Body Mass Index: The Importance of In-Store Contents

Most public health studies on the neighborhood food environment have focused on types of stores and their geographic placement, yet marketing research has long documented the influence of in-store shelf-space on consumer behavior. This paper combines these two strands of research to test whether the aggregate availability of specific foods in a neighborhood is associated with the BMIs of its residents. Fielded from October 2004 to August 2005, this study combines mapping of retail food outlets, in-store surveys, and telephone interviews of residents from 103 randomly sampled urban census tracts in southeastern Louisiana. Linear shelf-space of fruits, vegetables, and energy-dense snack foods was measured in 307 food stores in the study tracts. Residential addresses, demographic information, and heights and weights were obtained from 1243 respondents through telephone interviews. Cumulative shelf-space of foods within defined distances of each respondent was calculated using observations from the in-store survey and probability-based assignments of shelf-space to all unobserved stores in the area. After controlling for sociodemographic variables, income, and car ownership, regression analysis, conducted in 2008, showed that cumulative shelf-space availability of energy-dense snack foods was positively, although modestly, associated with BMI. A 100-meter increase in shelf-space of these foods within 1 kilometer of a respondent's household was associated with an additional 0.1 BMI points. Fruit and vegetable shelf-space was not significantly related to BMI. Interventions that seek to improve the neighborhood food environment may need to focus on more than just increasing access to healthy foods, because the results suggest that the availability of energy-dense snack foods plays a role in weight status.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents' eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12-15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents' diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescent's diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

The impact of gestational weight gain and diet on abnormal glucose tolerance during pregnancy in Hispanic women.

To examine the association of gestational weight gain and dietary factors with abnormal glucose tolerance (AGT). We conducted a prospective cohort study among 813 Hispanic prenatal care patients in Massachusetts. Gestational weight gain and oral glucose tolerance test results were abstracted from medical records. Dietary intake was assessed using a semi-quantitative food frequency questionnaire. Target weight gain was based on BMI-specific weekly weight gain rates established by the Institute of Medicine (IOM). We observed a statistically significant interaction between prepregnancy BMI and weight gain in relation to AGT (P < 0.01). Class II/III (BMI > or = 35 kg/m2) obese women who had a high rate of weight gain (>0.30 kg/week) or who exceeded target weight were 3-4 times as likely to develop AGT compared to women who gained within IOM ranges (OR = 4.2, 95% CI 1.1-16.0, OR = 3.2 95% CI 1.0-10.5, respectively). Decreasing levels of saturated fatty acids and energy-dense snack foods and increasing levels of fiber and polyunsaturated:saturated fat ratio were significantly associated with decreased risk of AGT, independent of gestational weight gain [corrected]. Weight gain among class II/III obese women and certain dietary components may represent modifiable risk factors for AGT.

Stress Reactivity and Adiposity of Youth

The relationship between stress reactivity and total or central adiposity in children has not been widely studied. Data from two studies were combined to determine the relationship between reactivity to interpersonal stress and the adiposity of children. Stress reactivity to an interpersonal stressor (speech) was measured in 36 boys (9.8 +/- 1.3 years of age) and 27 girls (9.3 +/- 1.3 years of age). Total adiposity (percentage body fat) was estimated from skinfolds and central adiposity from the abdominal girth. Multiple regression was used to establish the associations of change in perceived stress and heart rate reactivity with adiposity. Age, sex, ethnicity, and baseline perceived stress and heart rate served as covariates for total adiposity. Fat mass was included as an additional covariate for the prediction of log abdominal girth (central adiposity). Based on adjusted beta-weights, change in perceived stress (beta = 1.13, p <or= 0.001) and heart rate reactivity (beta = 0.14, p <or= 0.03) independently predicted percentage body fat. Heart rate reactivity (beta = 0.002, p <or= 0.04) independently predicted log abdominal girth. Reactivity to psychological stress may initiate the antecedents of cardiovascular disease before adolescence by increasing total and central adiposity. Future studies should determine whether stress reactivity increases the adiposity of youth by increasing their consumption of energy-dense snack foods and decreasing their willingness to be physically active.

Smoking, dietary restraint, gender, and the relative reinforcing value of snack food in a large university sample

The present study examined the independent and interactive association between smoking, gender, dietary restraint and the relative reinforcing value of snack food in a university sample. Four hundred and three introductory psychology students completed questionnaires assessing age, gender, BMI, hunger, smoking status, nicotine dependence, dietary restraint, hedonic ratings and the relative reinforcing value of snack food and fruits and vegetables. The relative reinforcing value of snack food was determined by the number of button presses subjects would be willing to do to obtain (100 g) of snack food versus 100 g of fruits and vegetables. Multiple regression analyses yielded a significant three-way interaction of gender, restraint, and smoking in predicting the relative reinforcing value of snack food indicating that in female smokers, dietary restraint was inversely associated with the relative reinforcing value of snack food, whereas in male smokers, restraint was not significantly related with the reinforcing value of snacks. These findings remained significant after controlling for BMI, hunger, and hedonics, suggesting that there are gender differences in relationship between smoking, dietary restraint, and snack food reinforcement. Among female university students, smoking moderates the relationship between dietary restraint and food reinforcement whereby high-restraint female smokers appear to be at lower risk of over-consuming energy dense snack food compared to low-restraint female smokers, while high-restraint male smokers may not be at higher risk than low-restraint male smokers.

Meal patterns and cooking practices in Southern France and Central England

AbstractObjectiveTo evaluate whether meal patterns and cooking practices in Central England and Mediterranean France conform to popular stereotypes, eating together as a household, preparation of meals, food purchasing patterns, cooking practices and eating out were investigated.DesignCross-sectional studies conducted simultaneously in April 2001 using self-administered postal questionnaires.SettingEngland (Nottingham, East Midlands) and France (Montpellier, Languedoc-Roussillon).SubjectsA stratified random sample of 1000 males and 1000 females aged 18–65 years was generated from the electoral roll in each country. The final sample comprised 826 subjects in England (58% males, 42% females; mean age 44 years) and 766 subjects in France (42% males, 58% females; mean age 42 years). Analyses were conducted on samples standardised for sociodemographic differences.ResultsThe French cooked from raw ingredients most often (P &lt; 0.001), ate together as a household more regularly (P &lt; 0.001) and were most likely to follow a regular meal pattern of three meals a day. On the other hand, the English relied more on ready-prepared (P &lt; 0.001) and take-away (P &lt; 0.001) meals, as well as on energy-dense snack foods such as crisps (P &lt; 0.001). Females in both countries reported having most responsibility for preparing meals.ConclusionsSome of the study's findings confirm popular stereotypes of French and English food cultures, as the importance of the convivial aspects of eating, as well as more traditional practices such as cooking meals from basic ingredients, structured mealtimes and less between-meal snacking, remain more prominent within the French population. This may contribute to the differences in prevalence of obesity seen between the two countries.

Meal patterns and cooking practices in Southern France and Central England

To evaluate whether meal patterns and cooking practices in Central England and Mediterranean France conform to popular stereotypes, eating together as a household, preparation of meals, food purchasing patterns, cooking practices and eating out were investigated. Cross-sectional studies conducted simultaneously in April 2001 using self-administered postal questionnaires. England (Nottingham, East Midlands) and France (Montpellier, Languedoc-Roussillon). A stratified random sample of 1000 males and 1000 females aged 18-65 years was generated from the electoral roll in each country. The final sample comprised 826 subjects in England (58% males, 42% females; mean age 44 years) and 766 subjects in France (42% males, 58% females; mean age 42 years). Analyses were conducted on samples standardised for sociodemographic differences. The French cooked from raw ingredients most often (P<0.001), ate together as a household more regularly (P<0.001) and were most likely to follow a regular meal pattern of three meals a day. On the other hand, the English relied more on ready-prepared (P<0.001) and take-away (P<0.001) meals, as well as on energy-dense snack foods such as crisps (P<0.001). Females in both countries reported having most responsibility for preparing meals. Some of the study's findings confirm popular stereotypes of French and English food cultures, as the importance of the convivial aspects of eating, as well as more traditional practices such as cooking meals from basic ingredients, structured mealtimes and less between-meal snacking, remain more prominent within the French population. This may contribute to the differences in prevalence of obesity seen between the two countries.

Relationship of mother and child food purchases as a function of price: A pilot study

To our knowledge, there are no data on parental influences on child purchasing behavior of healthy or unhealthy foods. Mothers and children in ten families were given $5.00 to purchase portions of preferred fruits/vegetables and high energy-dense snack foods for each of ten trials of price manipulations. For five of the trials the price of the fruit/vegetable increased in price from $0.50 to $2.50 (in $0.50 increments), while the price of the energy-dense snack food remained constant at $1.00. For the remaining five trials, the commodity that previously rose in price remained constant at $1.00 and the other commodity varied from $0.50 to $2.50. Same-price elasticity was shown for both the child and parent purchases, and parent purchases were significantly related to child purchases of both healthy (regression estimate=0.46, p<0.001) and unhealthy (regression estimate=0.12, p=0.036) foods. Children's purchases of unhealthy snack food items were positively related to family socioeconomic status, and negatively related to child age. These results indicate that parental food choice and purchasing behaviors may play a role in the development of children's purchasing of both healthy and unhealthy foods.

Provision of Foods Differing in Energy Density Affects Long‐Term Weight Loss

The energy density (kilocalories per gram) of foods influences short-term energy intake. This 1-year clinical trial tested the effect on weight loss of a diet incorporating one or two servings per day of foods equal in energy but differing in energy density. Dietitians instructed 200 overweight and obese women and men to follow an exchange-based energy-restricted diet. Additionally, subjects were randomized to consume daily either one or two servings of low energy-dense soup, two servings of high energy-dense snack foods, or no special food (comparison group). All four groups showed significant weight loss at 6 months that was well maintained at 12 months. The magnitude of weight loss, however, differed by group (p=0.006). At 1 year, weight loss in the comparison (8.1+/-1.1 kg) and two-soup (7.2+/-0.9 kg) groups was significantly greater than that in the two-snack group (4.8+/-0.7 kg); weight loss in the one-soup group (6.1+/-1.1 kg) did not differ significantly from other groups. Weight loss was significantly correlated with the decrease in dietary energy density from baseline at 1 and 2 months (p=0.0001) but not at 6 and 12 months. On an energy-restricted diet, consuming two servings of low energy-dense soup daily led to 50% greater weight loss than consuming the same amount of energy as high energy-dense snack food. Regularly consuming foods that are low in energy density can be an effective strategy for weight management.

Energy‐Dense Snack Food Intake in Adolescence: Longitudinal Relationship to Weight and Fatness

The longitudinal relationship between the consumption of energy-dense snack (EDS) foods and relative weight change during adolescence is uncertain. Using data from the Massachusetts Institute of Technology Growth and Development Study, the current analysis was undertaken to examine the longitudinal relationship of EDS food intake with relative weight status and percentage body fat and to examine how EDS food consumption is related to television viewing. One hundred ninety-six nonobese premenarcheal girls 8 to 12 years old were enrolled between 1990 and 1993 and followed until 4 years after menarche. At each annual follow-up visit, data were collected on percentage body fat (%BF), BMI z score, and dietary intake. Categories of EDS foods considered were baked goods, ice cream, chips, sugar-sweetened soda, and candy. At study entry, girls had a mean +/- SD BMI z score of -0.27 +/- 0.89, consumed 2.3 +/- 1.7 servings of EDS foods per day, and consumed 15.7 +/- 8.1% of daily calories from EDS foods. Linear mixed effects modeling indicated no relationship between BMI z score or %BF and total EDS food consumption. Soda was the only EDS food that was significantly related to BMI z score over the 10-year study period, but it was not related to %BF. In addition, a significant, positive relationship was observed between EDS food consumption and television viewing. In this cohort of initially nonobese girls, overall EDS food consumption does not seem to influence weight status or fatness change over the adolescent period.

Parental weight status and girls' television viewing, snacking, and body mass indexes.

The purpose of this study was to examine whether television viewing (TVV) provides a context for patterns of snacking fostering overweight in young girls from overweight and non-overweight families. Participants were 173 non-Hispanic white girls and their parents from central Pennsylvania, assessed longitudinally when girls were 5, 7, and 9 years old. Path analysis was used to test patterns of relationships among girls' TVV, snacking while watching television, snacking frequency, fat intake from energy-dense snack food, and girls' increase in body mass index (BMI) from age 5 to 9. In both overweight and non-overweight families, girls who watched more television consumed more snacks in front of the television. In families where neither parent was overweight, television viewing was the only significant predictor of girls' increase in BMI. In families where one or both parents were overweight, girls who watched more television snacked more frequently, and girls who snacked more frequently had higher intakes of fat from energy-dense snacks, which predicted their increase in BMI from age 5 to 9. TVV did not directly predict girls' increase in BMI in girls from overweight families. The results of this study support and extend previous findings that have shown that excessive television viewing and snacking patterns are risk factors for the development of overweight in children; however, patterns of relationships may differ based on parental weight status. For overweight families, TVV may provide a context for excessive snack consumption, in addition to inactivity.

Predictors of maternal child-feeding style: maternal and child characteristics

We investigated relationships among maternal and child characteristics, and two aspects of maternal child-feeding styles that may place daughters at risk for developing problems with energy balance. Participants included 104 overweight (BMI≥25) and 92 non-overweight (BMI<25) mothers and their 5-year-old, non-Hispanic, White daughters. Child-feeding styles included (a) restriction of daughters' intake of energy-dense snack food, and (b) pressure to eat more food. Predictors of child-feeding styles included measures of (1) maternal investment in weight and eating issues, including dietary restraint and weight concern, (2) child adiposity, (3) maternal perceptions of the child as underweight or overweight, and (4) maternal concern for child weight. Mothers reported using more restrictive feeding practices when they were invested in weight and eating issues, when they perceived daughters as overweight, when they were concerned about daughters' weight, and when daughters were heavier. Mothers reported using more pressure in child feeding when daughters were thinner, and when mothers perceived daughters as underweight. Further analyses examined whether relationships among child-feeding styles were different for overweight and non-overweight mothers. Overweight mothers' child-feeding styles appeared to be influenced by observable child weight characteristics, concerns for the child's weight status, and mothers' own history of overweight. Non-overweight mothers' child-feeding styles appeared to be influenced by distorted perceptions of and concerns for children, as well as distorted self-perceptions.

WHO tackles food inequalities: Europe's first comprehensive Food and Nutrition Action Plan debate, 8-10 November 1999, Malta.

Dietary habits are an important determinant of the major causes of morbidity and mortality (cardiovascular diseases, hypertension, stroke, non-insulin-dependent diabetes, obesity and some cancers) within the WHO European Region. Estimates suggest that 30–40% of some cancers are preventable by dietary means. In addition in 1995, 130 million Europeans suffered from food-borne illnesses. Recent scares related to bovine spongiform encephalitis (BSE) and dioxins have fuelled the concerns of consumers who no longer have confidence in government and industry to provide safe food. Access to a safe, healthy diet is one of the most important public health actions that a country can take to improve health and increase economic gain. Well coordinated action between the many players involved can reduce levels of disease, protect and promote health, and provide the added benefit of protecting the environment and stimulating socioeconomic growth and sustainable development. Growing the right kinds of foods for health can reduce fuel consumption, pollution, transport and packaging costs and promote biodiversity, especially if grown near where it is consumed. This can help create local jobs, improve food and nutrition security and promote a sustainable environment. The draft Food and Nutrition Action Plan discusses the need for a shift in traditional approaches to food inspection and end-product testing and calls for broader approaches to address changes in the food supply system (intensive agriculture and animal husbandry, mass production and distribution), in the new health and demographic situation (population growth, mainly urbanized and more vulnerable), and in the social situation, behaviour and lifestyles (increased travel, ethnic foods and increased food trade). The Plan calls for better and more accessible food and nutrition information systems, improved pricing and advertising policies. Marketing aimed at children, focusing on high-fat and energy-dense snack foods is raised as a concern. The Plan also calls for ministries of health to participate more in Codex committees and to be represented on delegations attending World Trade Organization committees. In addition National Food Control agencies have to consider how best to respond to consumers fears and demands for safer food. The Plan proposes that each WHO European Member State establish or strengthen intersectoral mechanisms to secure better coordination between different ministries dealing with food and nutrition – seeing to it that public health concerns are taken into account. At present, responsibility for the food system is divided among various ministries and sectors including trade, labour, tourism, education, finance, environment and health. Unless actions are coordinated there is a risk of duplication or – even more likely – the risk that certain public health concerns could be overlooked in efforts to promote economic activity. In addition, global food trade makes it more difficult to contain food-borne diseases within national borders, so effective international and regional health strategies are needed. To achieve effective action in the WHO European Region, it is proposed that a Food and Nutrition Committee for Europe be set up to support the development and implementation of action plans, and to advise on international aspects of food control and nutrition policy. The draft First Food and Nutrition Action Plan will be presented to the WHO Regional Committee for Europe in September 2000.