The Influence of Snacking on Energy Intake in Young Children

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1 The Influence of Snacking on Energy Intake in Young Children Chelsi C. Cardoso, MS, RD, LDN Research Associate, III Healthy Eating and Activity Laboratory Department of Nutrition

2 Presentation Objectives Describe the concept of energy self-regulation Review research regarding energy self-regulation capabilities in young children Discuss implications of how energy self-regulation capabilities in young children influence the ability to achieve a healthy weight Review the role of snacks within young children s diets Describe what is needed to develop an evidence-base for developing participatory guidance regarding the role of snacks in young children s diets

3 Energy Self-Regulation

4 Energy Self-Regulation Energy self-regulation is the idea that a person can modify his/her energy intake based upon the energy content of the overall diet (1) Eating like a bird Eating like a horse

5 Research on Energy Self- Regulation in Young Children Initial studies (1,2) demonstrated young children can modify food intake based upon overall energy content of the diet, suggesting self-regulation This self-regulation was demonstrated: Within one eating occasion i.e. children adjusted intake after consuming a low calorie or high calorie preload, such that they consumed more or less calories at a meal following the preload Over several eating occasions i.e. children s individual meal consumption is highly variable throughout the course of the day, but overall energy intake over the course of the day was relatively constant

6 Research on Energy Self- Regulation in Young Children Newer studies (3-9) demonstrated that environmental cues can impact energy intake in young children, suggesting a lack of selfregulation Cues that impact energy intake include: Portion size (3-5, 9) i.e. increasing portion size resulted in an increase in energy consumed in young children Energy density (6-9) i.e. increasing energy density of an entrée or beverage by ~30% resulted in a 25% increase in energy consumed in young children

7 Research on Energy SelfRegulation in Young Children Inconsistencies and changes in results could be due to: Study design differences Changes in the environment over time Children s changes in responsiveness to the environment over time

8 Energy Self-Regulation in Young Children and Weight Status Children are often provided Large portion sizes Snacks High-energy-dense foods If children are able to self-regulate intake this would suggest that children would remain at a healthy weight, even if energy is offered to children outside of what daily needs are Disruption of self-regulation of intake could lead to excess energy consumption, especially if energy is offered to children outside of what daily needs are

9 Role of Snacking in Young Children

10 Snacking in Young Children (10)

11 Snacking in Young Children Snacking appears to be a major contribution to overall intake in young children National survey data shows increases in the number and size (i.e. calories) of snacks consumed by US children from to (10) In 2006, 2 to 6 year-old children consumed 500 kcal from snacks daily across 2-3 snacking occasions (10)

needed for healthy growth View Two Snacking promotes

12 Snacking in Young Children View One Snacking helps young children consume appropriate amounts of nutrients and energy needed for healthy growth View Two Snacking promotes excessive intake of nutrient-poor foods and energy, increasing obesity risk

13 Snacking in Young Children The National Health and Nutrition Examination Study (NHANES) indicate that US preschoolers consume close to one-third of their daily energy intakes from snacks (10-12) These data could suggest snacks may help some young children meet energy needs

14 Snacking in Young Children Snacks have been observed to provide >25% of calcium, potassium, and Vitamin D intakes among US children aged 2 to 5 years in (11) These data could suggest that snacks enhance young children s diet quality by contributing important nutrients

15 Snacking in Young Children Along with increases in snacking frequency and size, increases in total daily energy intake among US preschoolers from to have been observed (13) These data could suggest snacks could be problematic and contribute to excessive energy intake

16 Snacking in Young Children The top snack foods consumed by US children aged 2 to 18 years were observed as desserts, sweetened beverages, and salty snacks (10,14) These data could suggest that snacks are not as nutrient-dense as meals (14) and contain high levels of solid fats and added sugars, (10,14) which are thought to promote excessive energy intake (11,14)

17 Snacking in Young Children Descriptive and observational studies have produced unclear findings as to whether snacking has helpful or harmful effects on energy intake among young children

18 Summary of Snacking in Young Children Snacks are a fixture in the diets of most young children Evidence regarding snacking is limited and lacking due to reliance on observational designs and caretaker-reported dietary data that do not permit causal inference It is currently unknown whether snacking has helpful, harmful, or negligible effects on young children s energy intake Consequently, current recommendations and policies on child snacking are without appreciable scientific basis

19 Our Pilot Data

20 Our Pilot Data We collected preliminary data in collaboration with the Early Learning Center to obtain initial estimates of snacking frequency effects on daily energy intake among 10 preschoolaged children years old body mass index z-score [zbmi] 70% male 70% white 90% non-hispanic

21 Our Pilot Data A within-subjects design was used where each child was seen in 3 conditions using a single menu that varied in: the number of snacks and total energy provided during an 11-hour period

22 Our Pilot Data REFERENCE: 3M 3M+2S: ME 3M+2S: EE Ea.ng Occasion Calories Provided Ea.ng Occasion Calories Provided Ea.ng Occasion Breakfast 500 Breakfast 400 Breakfast 500 Morning Snack 260 Morning Snack 260 Lunch 750 Lunch 540 Lunch 750 A;ernoon Snack 260 A;ernoon Snack 260 Dinner 750 Dinner 540 Dinner 750 Calories Provided Day Total:

23 Our Pilot Data Food at Breakfast Yoplait Light Yogurt, Strawberry Kellog s Nutrigrain Cereal Bars, Blueberry Strawberries, Fresh (sliced in halves) Water Food at Morning Snack Nature s Own Cinnamon Raisin Bagel Water Food at Lunch I.M. Healthy SoyNut BuUer, Creamy Smuckers Concord Grape Jelly Arnold Whole Wheat Baby Carrots, Fresh, Medium MoU s Natural No Sugar Added Applesauce Mayfield Nurture 1% Milk Food at AGernoon Snack Nabisco Triscuit Reduced Fat Crackers Kra; Natural Cheese cubes, Mild Cheddar Water Food at Dinner Tyson Grilled and Ready Fully Cooked Frozen Chicken Breast Fillets MorningStar Farms Garden Veggie Pa_es OreIda Steam n Mash Cut Russet Potatoes Minute White Rice Pictsweet Steamables Broccoli Florets Baby Carrots, Fresh, Medium Dole Mandarin Oranges in Syrup Dole Tropical Fruit in Syrup Mayfield Nurture 1% Milk

400 874 725 893 200 0 REFERENCE: 3M (2000 KCAL

24 Our Pilot Data p = 0.001* p = Meals Snacks Kcal REFERENCE: 3M (2000 KCAL PROVIDED) 3M+2S:ME (2000 KCAL PROVIDED) 3M+2S:EE (2520 KCAL PROVIDED) Session

25 Our Pilot Data These findings provide initial evidence that Preschool-aged children do not appear to compensate for energy consumed from snacks at later meals; and Reducing meal size may offset additional energy consumed from snacks

26 Our Pilot Data Dietary quality of the three conditions was assessed using the Healthy Eating Index-2010 (HEI-2010) The HEI was developed to measure compliance of diets to the Dietary Guidelines, with the HEI-2010 reflecting compliance to the 2010 Dietary Guidelines HEI-2010 controls for the size and amount of food consumed by having all components reported in functions of 1,000 kcal

27 Our Pilot Data These results suggest that snacks do not appear to improve overall dietary quality, especially if they are providing extra energy beyond that provided by meals

28 Future Research Considerations for the Development of an Evidence Base

29 Future Research Scientific understanding of snacking among young children needs to be broadened in a number of important ways we need experimental evidence of the effects of snacking on daily energy intake

30 Future Research Scientific understanding of snacking among young children needs to be broadened in a number of important ways we need to consider the frequency and size of snacks as well as the size of accompanying meals

31 Future Research Scientific understanding of snacking among young children needs to be broadened in a number of important ways we need to determine if the effects of snacking are moderated by weight status, food motivation, and satiety responsiveness

32 Future Research Scientific understanding of snacking among young children needs to be broadened in a number of important ways we need to evaluate snacking within the context of existing policies and guidelines (i.e., CACFP)

33 References 1. Birch LL, Johnson SL, Andresen G, Peters JC, Schulte MC. The Variability of Young Childrens Energy-Intake. New England Journal of Medicine. Jan ;324(4): Birch LL, Deysher M. Caloric Compensation and Sensory Specific Satiety - Evidence for Self Regulation of Food-Intake by Young-Children. Appetite. Dec 1986;7(4): Fisher JO. Effects of age on children's intake of large and self-selected food portions. Obesity. Feb 2007;15(2): Rolls BJ, Engell D, Birch LL. Serving portion size influences 5-year-old but not 3-year-old children's food intakes. Journal of the American Dietetic Association. Feb 2000;100(2): Fisher JO, Rolls BJ, Birch LL. Children's bite size and intake of an entree are greater with large portions than with age-appropriate or selfselected portions. American Journal of Clinical Nutrition. May 2003;77(5): Leahy KE, Birch LL, Rolls BJ. Reducing the energy density of an entree decreases children's energy intake at lunch. Journal of the American Dietetic Association. Jan 2008;108(1): Fisher J, Liu Y, Birch LL, Rolls BJ. Effects of portion size and energy density on young children's intake at a meal. American Journal of Clinical Nutrition. Jul 2007;86(1): Leahy KE, Birch LL, Fisher JO, Rolls BJ. Reductions in entree energy density increase children's vegetable intake and reduce energy intake. Obesity. Jul 2008;16(7): Looney SM, Raynor HA. Impact of Portion Size and Energy Density on Snack Intake in Preschool-Aged Children. Journal of the American Dietetic Association. Mar 2011;111(3): Piernas C, Popkin BM. Trends in snacking among U.S. children. Health affairs. Mar-Apr 2010;29(3): U.S. Department of Agriculture, Agricultural Research Service. Snacks: Percentages of selected nutrients contributed by foods eaten at snack occasions, by gender and age, in the United States, What We Eat in America, NHANES ; SP2UserFiles/Place/ /pdf/0910/Table_25_SNK_GEN_09.pdf. Accessed March 10, Ziegler P, Hanson C, Ponza M, Novak T, Hendricks K. Feeding Infants and Toddlers Study: meal and snack intakes of Hispanic and non- Hispanic infants and toddlers. J Am Diet Assoc. Jan 2006;106(1 Suppl 1):S Slining MM, Mathias K, Popkin BM. Trends in food and beverage sources among US children and adolescent: Journal of the Academy of Nutrition and Dietetics. 2013;113(12): Hess J, Slavin J. Snacking for a cause: nutritional insufficiencies and excesses of US children, a critical review of food consumption patterns and macronutrient and micronutrient intake of US children. Nutrients. 2014;6:

34 QUESTIONS?

35 Save the Date! Promoting Healthy Weight 2.0 Friday, September 30, :30pm 5:00pm EDST (onsite) 12:45pm 5:00pm EDST (online) This Project is supported by the Health Resources and Services Administration (HRSA) of the U.S Department of Health and Human Services (HHS) under grant number T79MC09805, Leadership Education in Maternal and Child Health Nutrition, $176,795, 50% funded by the University of Tennessee, Department of Nutrition. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Meal Menu Approximate Amount Eaten

Meal Menu Approximate Amount Eaten Myself 16 Year Old Active Male Teen 3 Year Old Female Child ¼ cup 1 slice 70 Year Old Female Breakfast Special K Cereal(red berries) 1 cup 1 Banana (slices) ¼ cup ¾ cup