Snacking Characteristics and Patterns in the Childhood Obesity Prevention and Treatment Research Consortium
Authors: LeCroy Madison N , Truesdale Kimberly P , Matheson Donna , Thomas Alicia , Moore Shirley , Robinson Thomas , French Simone , Berge Jerica , Karp Sharon , Nicastro Holly 
Published: November 2023

IntroductionSnack occasions account for up to 25% of total daily caloric intake among children aged 2–11 years, but it is unclear how snacking is related to dietary quality and obesity. The objective of this study is to describe snacking characteristics and patterns in children and to examine their associations with dietary quality and body mass index (BMI).MethodsData were collected at baseline from four randomized trials of predominantly low‐income, racial/ethnic minorities from the Childhood Obesity Prevention and Treatment Research (COPTR) Consortium. Study sites were in Minneapolis, MN (n=534 2–4‐year‐olds ≥50th BMI percentile); Nashville, TN (n=610 3–5‐year‐olds ≥50th to <95th BMI percentile); San Francisco Bay Area, CA (n=241 7–11‐year‐olds ≥85th BMI percentile); and Cleveland, OH (n=360 10–13‐year‐olds ≥85th BMI percentile). Children's weight and height were measured. Participants or an adult proxy completed three 24‐hour dietary recalls and self‐identified snack occasions. Snack patterns were derived for each site from 11 food groups using principal factor analysis. Estimated scoring coefficients for each derived factor determined pattern adherence. Multivariable models were used to examine associations of snacking characteristics (total number of occasions and calories) and snack pattern adherence with total COPTR‐modified healthy eating index (mHEI) score and BMI.ResultsSnacks accounted for a greater percent of total number of meals (43% vs. 27%) and total caloric intake (30% vs. 17%) for younger versus older children, respectively. In younger children, total number of snack occasions was positively associated with mHEI [MN: 0.50 (95% CI: 0.10, 0.90); TN: 0.68 (95% CI: 0.25, 1.11)]. Two snack patterns were derived for three sites: a meal‐like factor (non‐starchy vegetables, meats, and grains) and a beverage factor [milk and sugar‐sweetened beverages (SSBs)]. Two different snack patterns were derived for Cleveland, OH, a similar meal‐like factor (non‐starchy vegetables, starchy vegetables, meats, and SSBs) and a dairy food/grain‐based factor. Increased adherence to a meal‐like pattern was positively associated with mHEI among younger children only [MN: 3.48 (95% CI: 1.90, 5.06); TN: 2.31 (95% CI: 0.89, 3.74)]. Other associations of snacking characteristics and patterns with mHEI and BMI varied across sites.ConclusionsThe factors that described predominantly low‐income, racial/ethnic minority children's snack patterns were a meal‐like factor and a beverage factor. Meal‐like factor snack consumption was associated with better dietary quality only among younger children, who obtained a greater proportion of their total caloric intake from snacks compared to older children. These results indicate that targeting snack intake may be relevant to improving the diets of 2–5‐year‐old children.Support or Funding InformationThe project described was supported by grant numbers U01HL103561, U01HL103620, U01HL103622, U01HL103629, and U01HD068890 from the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Development; and the National Institutes of Health Office of Behavioral and Social Sciences Research.