Snacking patterns, diet quality, and cardiovascular risk factors in adults

BMC Public Health

Victor L Fulgoni III¹  Carol E O’Neil³  Theresa A Nicklas² 

[1] Nutrition Impact LLC, 9725 D Drive North, Battle Creek, MI 49014, USA;Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children’s Nutrition Research Center, 1100 Bates Ave, Houston, TX 77030, USA;School of Nutrition and Food Sciences, Louisiana State University Agricultural Center, 261 Knapp Hall, 110 LSU Union Square, Baton Rouge, LA 70803, USA

关键词: Diet quality;    Cardiovascular risk factors;    Abdominal obesity;    Overweight;    Snacking patterns;    Adults;   

Others  :  1131494
DOI  :  10.1186/1471-2458-14-388

 received in 2013-05-31, accepted in 2014-04-07,  发布年份 2014

【 摘 要 】

Background

The relationship of snacking patterns on nutrient intake and cardiovascular risk factors (CVRF) in adults is unknown. The aim of this study was to examine the associations of snacking patterns with nutrient intake, diet quality, and a selection of CVRF in adults participating in the 2001-2008 National Health and Nutrition Examination Survey.

Methods

24-hour dietary recalls were used to determine intake and cluster analysis was used to identify the snacking patterns. Height and weight were obtained and the health indices that were evaluated included diastolic and systolic blood pressure, high density lipoprotein-cholesterol, low density lipoprotein cholesterol, triacylglycerides, blood glucose, and insulin.

Results

The sample was participants (n = 18,988) 19+ years (50% males; 11% African-Americans; 72% white, 12% Hispanic-Americans, and 5% other). Cluster analyses generated 12 distinct snacking patterns, explaining 61% of the variance in snacking. Comparisons of snacking patterns were made to the no snack pattern. It was found that miscellaneous snacks constituted the most common snacking pattern (17%) followed by cakes/cookies/pastries (12%) and sweets (9%). Most snacking patterns were associated with higher energy intakes. Snacking patterns cakes/cookies/pastries, vegetables/legumes, crackers/salty snacks, other grains and whole fruit were associated with lower intakes of saturated fatty acids. Added sugars intakes were higher in the cakes/cookies/pastries, sweets, milk desserts, and soft drinks patterns. Five snack patterns (cakes/cookies/pastries, sweets, vegetable/legumes, milk desserts, soft drinks) were associated with lower sodium intakes. Several snack patterns were associated with higher intakes of potassium, calcium, fiber, vitamin A, and magnesium. Five snacking patterns (miscellaneous snacks; vegetables/legumes; crackers/salty snacks; other grains; and whole fruit) were associated with better diet quality scores. Alcohol was associated with a lower body mass index and milk desserts were associated with a lower waist circumference. No snack patterns were associated with other CVRF studied.

Conclusions

Overall, several snacking patterns were associated with better diet quality than those consuming no snacks. Yet, the majority of the snacking patterns were not associated with CVRF. Education is needed to improve snacking patterns in terms of nutrients to limit in the diet along with more nutrient-dense foods to be included in snacks.

【 授权许可】

   
2014 Nicklas et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief 2012, (82):1-8. http://www.ncbi.nlm.nih.gov/pubmed/22617494 webcite
• [2]NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Obesity in Adults (US): Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda (MD): National Heart, Lung, and Blood Institute; 1998. http://www.ncbi.nlm.nih.gov/books/NBK2003/ webcite
• [3]Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB: The metabolic syndrome: prevalence and associated risk factor findings in the US population from the third national health and nutrition examination survey, 1988-1994. Arch Intern Med 2003, 163(4):427-436.
• [4]Bungum T, Satterwhite M, Jackson AW, Morrow JR Jr: The relationship of body mass index, medical costs, and job absenteeism. Am J Health Behav 2003, 27(4):456-462.
• [5]Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB: Years of life lost due to obesity. JAMA 2003, 289(2):187-193.
• [6]Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP: Self-reported body mass index and health-related quality of life: findings from the behavioral risk factor surveillance system. Obes Res 2001, 9(1):21-31.
• [7]Sturm R, Ringel JS, Andreyeva T: Increasing obesity rates and disability trends. Health Aff (Millwood) 2004, 23(2):199-205.
• [8]Burton WN, Chen CY, Schultz AB, Edington DW: The costs of body mass index levels in an employed population. Stat Bull Metrop Insur Co 1999, 80(3):8-14.
• [9]Cawley J, Meyerhoefer C: The medical care cost of obesity: an instrumental variables approach. J Health Econ 2012, 31(1):219-230.
• [10]Piernas C, Popkin B: Snacking increased among U.S. adults between 1977 and 2006. J Nutr 2010, 140(2):325-332.
• [11]Hampl JS, Heaton CL, Taylor CA: Snacking patterns influence energy and nutrient intakes but not body mass index. J Hum Nutr Diet 2003, 16(1):3-11.
• [12]Piernas C, Popkin B: Trends in snacking among U.S. children. Health Aff 2010, 29(3):398-404.
• [13]Jahns L, Siega-Riz AM, Popkin BM: The increasing prevalence of snacking among US children from 1977 to 1996. J Pediatr 2001, 138(4):493-498.
• [14]Kerr MA, Rennie KL, McCaffrey TA, Wallace JM, Hannon-Fletcher MP, Livingstone MB: Snacking patterns among adolescents: a comparison of type, frequency and portion size between Britain in 1997 and Northern Ireland in 2005. Br J Nutr 2009, 101(1):122-131.
• [15]Nielsen SJ, Popkin BM: Patterns and trends in food portion sizes, 1977-1998. JAMA 2003, 289(4):450-453.
• [16]Kerver JM, Yang EJ, Obayashi S, Bianchi L, Song WO: Meal and snack patterns are associated with dietary intake of energy and nutrients in US adults. J Am Diet Assoc 2006, 106(1):46-53.
• [17]Cross AT, Babicz D, Cushman LF: Snacking patterns among 1,800 adults and children. J Am Diet Assoc 1994, 94(12):1398-1403.
• [18]Zizza C, Xu B: Snacking is associated with overall diet quality among adults. J Acad Nutr Diet 2012, 112(2):291-296.
• [19]Fabry P, Fodo J, Hejl Z, Braun T, Zvolankova K: The frequency of meals: Its relation to overweight, hypercholesterolaemia, and decreased glucose tolerance. Lancet 1964, 2(7360):614-615.
• [20]Larson N, Story M: A review of snacking patterns among children and adolescents: what are the implications of snacking for weight status? Child Obes 2013, 9(2):104-115.
• [21]Miller R, Benelam B, Stanner S, Buttriss J: Is snacking good or bad for health: an overview. Nutr Bull 2013, 38(3):302-322.
• [22]Booth DA: Mechanisms from models–actual effects from real life: the zero-calorie drink-break option. Appetite 1988, 11(Suppl 1):94-102.
• [23]Basdevant A, Craplet C, Guy-Grand B: Snacking patterns in obese French women. Appetite 1993, 21(1):17-23.
• [24]Drummond S, Crombie N, Kirk T: A critique of the effects of snacking on body weight status. Eur J Clin Nutr 1996, 50(12):779-783.
• [25]Keast D, Nicklas T, O'Neil C: Snacking is associated with reduced risk of overweight and reduced abdominal obesity in adolescents: NHANES 1999-2004. Am J Clin Nutr 2010, 92(2):428-435.
• [26]Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C: Relationship between feeding pattern and body mass index in 220 free-living people in four age groups. Eur J Clin Nutr 1996, 50(8):513-519.
• [27]Phillips SM, Bandini LG, Naumova EN, Cyr H, Colclough S, Dietz WH, Must A: Energy-dense snack food intake in adolescence: longitudinal relationship to weight and fatness. Obes Res 2004, 12(3):461-472.
• [28]Andersson I, Rossner S: Meal patterns in obese and normal weight men: the 'Gustaf' study. Eur J Clin Nutr 1996, 50(10):639-646.
• [29]Field AE, Austin SB, Gillman MW, Rosner B, Rockett HR, Colditz GA: Snack food intake does not predict weight change among children and adolescents. Int J Obes Relat Metab Disord 2004, 28(10):1210-1216.
• [30]Kant AK, Graubard BI: Secular trends in patterns of self-reported food consumption of adult Americans: NHANES 1971-1975 to NHANES 1999-2002. Am J Clin Nutr 2006, 84(5):1215-1223.
• [31]Howarth NC, Huang TT, Roberts SB, Lin BH, McCrory MA: Eating patterns and dietary composition in relation to BMI in younger and older adults. Int J Obes (Lond) 2007, 31(4):675-684.
• [32]Summerbell CD, Moody RC, Shanks J, Stock MJ, Geissler C: Sources of energy from meals versus snacks in 220 people in four age groups. Eur J Clin Nutr 1995, 49(1):33-41.
• [33]Ovaskainen ML, Reinivuo H, Tapanainen H, Hannila ML, Korhonen T, Pakkala H: Snacks as an element of energy intake and food consumption. Eur J Clin Nutr 2006, 60(4):494-501.
• [34]Drummond SE, Crombie NE, Cursiter MC, Kirk TR: Evidence that eating frequency is inversely related to body weight status in male, but not female, non-obese adults reporting valid dietary intakes. Int J Obes Relat Metab Disord 1998, 22(2):105-112.
• [35]Heidemann C, Scheidt-Nave C, Richter A, Mensink GB: Dietary patterns are associated with cardiometabolic risk factors in a representative study population of German adults. Br J Nutr 2011, 106(8):1253-1262.
• [36]Vergetaki A, Linardakis M, Papadaki A, Kafatos A: Presence of metabolic syndrome and cardiovascular risk factors in adolescents and University students in Crete (Greece), according to different levels of snack consumption. Appetite 2011, 57(1):278-285.
• [37]Yu R, Woo J, Chan R, Sham A, Ho S, Tso A, Cheung B, Lam T, Lam K: Relationship between dietary intake and the development of type 2 diabetes in a Chinese population: the Hong Kong dietary survey. Publ Health Nutr 2011, 14(7):1133-1141.
• [38]Oba S, Nagata C, Nakamura K, Fujii K, Kawachi T, Takatsuka N, Shimizu H: Diet based on the Japanese food guide spinning toop and subsequent mortality among men and women in a general Japanese population. J Am Diet Assoc 2009, 109(9):1540-1547.
• [39]Mekary RA, Giovannucci E, Willett WC, van Dam RM, Hu FB: Eating patterns and type 2 diabetes risk in men: breakfast omission, eating frequency, and snacking. Am J Clin Nutr 2012, 95(5):1182-1189.
• [40]National Center for Health Statistics: Analytic and Reporting Guidelines: The National Health and Nutrition Examination Survey (NHANES). 2006. Available at: http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/nhanes_analytic_guidelines_dec_2005.pdf webcite
• [41]Moshfegh AJ, Rhodes DG, Baer DJ, Murayi T, Clemens JC, Rumpler WV, Paul DR, Sebastian RS, Kuczynski KJ, Ingwersen LA, Staples RC, Cleveland LE: The US department of agriculture automated multiple-pass method reduces bias in the collection of energy intakes. Am J Clin Nutr 2008, 88(2):324-332.
• [42]Moshfegh A, Borrund L, Perloff B, LaComb R: Improved method for the 24-hour dietary recall for use in national surveys. FASEB J 1999, 13:A603.
• [43]Anand J, Goldman J, LaComb R: An approved approach to 24-hour dietary recall methodology. Ann Nutr Metab 2001, 45(Suppl 1):156.
• [44]Conway JM, Ingwersen LA, Vinyard BT, Moshfegh AJ: Effectiveness of the US department of agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women. Am J Clin Nutr 2003, 77(5):1171-1178.
• [45]Centers for Disease Control and Prevention: NHANES Dietary Interview Component. http://www.cdc.gov/nchs/data/nhanes/nhanes_09_10/dietaryrecall_f.pdf webcite
• [46]U.S. Department of Agriculture, Agricultural Research Service: USDA Food and Nutrient Database for Dietary Studies, Versions 1.0 - 4.1 Documentation and User Guide, 2004, 2006, and 2008. http://www.ars.usda.gov/Services/docs.htm?docid=12089 webcite
• [47]United States Department of Agriculture: Center for Nutrition Policy and Promotion. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans. 2010. Available at: http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm webcite
• [48]Friday J, Bowman S: MyPyramid Equivalents Database for USDA Survey Food Codes, 1994-2002 Version 1.0. 2006. http://www.barc.usda.gov/bhnrc/cnrg webcite
• [49]Bowman SA, Friday JE, Moshfegh A: MyPyramid Equivalents Database, 2.0 for USDA Survey Foods, 2003-2004 Food Surveys Research Group. 2006. http://www.ars.usda.gov/ba/bhnrc/fsrg webcite
• [50]U.S. Department of Agriculture, Center for Nutrition Policy and Promotion: Healthy Eating Index-2005 Development and Evaluation Technical Report Support Files. Available at: http://www.cnpp.usda.gov/HealthyEatingIndex-2005report.htm webcite
• [51]Kennedy E, Ohls J, Carlson S, Fleming K: The healthy eating index: design and applications. J Am Diet Assoc 1995, 95(10):1103-1108.
• [52]Guenther PM, Reedy J, Krebs-Smith SM: Development of the healthy eating index-2005. J Am Diet Assoc 2008, 108(11):1896-1901.
• [53]Guenther PM, Reedy J, Krebs-Smith SM, Reeve BB: Evaluation of the healthy eating index-2005. J Am Diet Assoc 2008, 108(11):1854-1864.
• [54]United States Department of Agriculture: Center for Nutrition Policy and Promotion. Calculation of the Healthy Eating Index-2005 component and total scores for a population, subpopulation, or group. Available at: http://www.cnpp.usda.gov/Publications/HEI/HEI-2005/Readme_HEI2005_NHANES0102PopulationScore.doc webcite. (Accessed 12/20/13)
• [55]National Health and Nutrition Examination Survey: Physical Activity and Physical Fitness. http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/paq07_08_eng.pdf webcite
• [56]Centers for Disease Control and Prevention: National Center for Health Statistics. National Health and Nutrition Examination Survey. Anthropometry Manual. http://www.cdc.gov/nchs/data/nhanes/bm.pdf webcite
• [57]National Cholesterol Education Program: National Heart, Lung, and Blood Institute. National Institutes of Health. Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). http://www.nhlbi.nih.gov/about/ncep/ webcite
• [58]Centers for Disease Control and Prevention: National Center for Health Statistics. National Health and Nutrition Examination Survey (NHANES). Physician Examination Procedures Manual. Available at: http://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/manual_pe.pdf webcite
• [59]Centers for Disease Control and Prevention: National Center for Health Statistics, NHANES. Laboratory Methods. http://www.cdc.gov/nchs/nhanes/nhanes1999-2000/lab99_00.htm webcite, http://www.cdc.gov/nchs/nhanes/nhanes2001-2002/lab01_02.htm webcite, http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/lab03_04.htm webcite, http://www.cdc.gov/nchs/nhanes/nhanes2005-2006/lab_methods_05_06.htm webcitehttp://www.cdc.gov/nchs/data/nhanes/gendoc.pdf webcite
• [60]National Institutes of Health, National Heart Lung and Blood Institute: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Obes Res 1998, 6(Suppl 2):51S-209S.
• [61]Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC Jr, Spertus JA, Costa F: Diagnosis and management of the metabolic syndrome: an American heart association/national heart, lung, and blood institute scientific statement. Circulation 2005, 112(17):2735-2752.
• [62]Quon MJ: Limitations of the fasting glucose to insulin ratio as an index of insulin sensitivity. J Clin Endocrinol Metab 2001, 86(10):4615-4617.
• [63]International Expert Committee: International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009, 32(7):1327-1334.
• [64]Dinavahi R, Falkner B: Relationship of homocysteine with cardiovascular disease and blood pressure. J Clin Hypertens (Greenwich) 2004, 6(9):494-498. quiz 499-500
• [65]National Institutes of Health. National Heart, Lung, and Blood Institute: National Cholesterol Education Program (2001) Adult Treatment Panel III Executive Summary Report. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm webcite
• [66]Development and Evaluation of the Healthy Eating Index-2005: Technical Report. Center for Nutrition Policy and Promotion, U.S. Department of Agriculture. 2007. http://www.cnpp.usda.gov/HealthyEatingIndex.htm webcite
• [67]Bhupathiraju SN, Tucker KL: Coronary heart disease prevention: nutrients, foods, and dietary patterns. Clin Chim Acta 2011, 412(17–18):1493-1514.
• [68]Kant AK: Dietary patterns: biomarkers and chronic disease risk. Appl Physiol Nutr Metab 2010, 35(2):199-206.
• [69]Tucker KL: Dietary patterns, approaches, and multicultural perspective. Appl Physiol Nutr Metabol Physiol Appl Nutr Metabol 2010, 35(2):211-218.
• [70]Judd SE, Gutierrez OM, Newby PK, Howard G, Howard VJ, Locher JL, Kissela BM, Shikany JM: Dietary patterns are associated with incident stroke and contribute to excess risk of stroke in black Americans. Stroke 2013, 44(12):3305-3311. http://www.ncbi.nlm.nih.gov/pubmed/24159061 webcite
• [71]Kimokoti RW, Gona P, Zhu L, Newby PK, Millen BE, Brown LS, D'Agostino RB, Fung TT: Dietary patterns of women are associated with incident abdominal obesity but not metabolic syndrome. J Nutr 2012, 142(9):1720-1727. http://www.ncbi.nlm.nih.gov/pubmed/22833658 webcite
• [72]Liu E, McKeown NM, Newby PK, Meigs JB, Vasan RS, Quatromoni PA, D'Agostino RB, Jacques PF: Cross-sectional association of dietary patterns with insulin-resistant phenotypes among adults without diabetes in the Framingham Offspring Study. Br J Nutr 2009, 102(4):576-583.
• [73]Newby PK, Tucker KL: Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev 2004, 62(5):177-203.
• [74]Wang L, Lee IM, Manson JE, Buring JE, Sesso HD: Alcohol consumption, weight gain, and risk of becoming overweight in middle-aged and older women. Arch Intern Med 2010, 170(5):453-461.
• [75]Lopez-Garcia E, Van Dam RM, Rajpathak S, Willett WC, Manson JE, Hu FB: Changes in caffeine intake and long-term weight change in men and women. Am J Clin Nutr 2006, 83(3):674-680.
• [76]Mohindra NA, Nicklas TA, O'Neil CE, Yang SJ, Berenson GS: Eating patterns and overweight status in young adults: the Bogalusa Heart Study. Int J Food Sci Nutr 2009, 60(Suppl 3):14-25.
• [77]Nicklas TA, Yang SJ, Baranowski T, Zakeri I, Berenson G: Eating patterns and obesity in children: the Bogalusa Heart Study. Am J Prev Med 2003, 25(1):9-16.
• [78]Food and Nutrition Board: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. http://iom.edu/Reports/2002/Dietary-Reference-Intakes-for-Energy-Carbohydrate-Fiber-Fat-Fatty-Acids-Cholesterol-Protein-and-Amino-Acids.aspx webcite
• [79]Schunk J, McArthur L, Maahs-Fladung C: Correlates for healthful snacking among middle-income Midwestern Women. J Nutr Educ Behav 2009, 41:274-280.
• [80]Siri-Tarino P, Sun Q, Hu F, Krauss R: Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients. Curr Atherosclerosis Rep 2010, 12(6):384-390.
• [81]Astrup A, Dyerberg J, Elwood P, Hermansen K, Hu FB, Jakobsen MU, Kok FJ, Krauss RM, Lecerf JM, LeGrand P, Nestel P, Riserus U, Sanders T, Sinclair A, Stender S, Tholstrup T, Willett WC: The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010? Am J Clin Nutr 2011, 93(4):684-688.
• [82]Thompson FE, Byers T: Dietary assessment resource manual. J Nutr 1994, 124(11 Suppl):2245S-2317S.
• [83]Poslusna K, Ruprich J, de Vries J, Jakubikova M, van't Veer P: Misreporting of energy and micronutrient intake estimated by food records and 24 hour recalls, control and adjustment methods in practice. Br J Nutr 2009, 101(Suppl 2):S73-S85.
• [84]Champagne CM, Baker NB, DeLany JP, Harsha DW, Bray GA: Assessment of energy intake underreporting by doubly labeled water and observations on reported nutrient intakes in children. J Am Diet Assoc 1998, 98(4):426-433.