Snacks as an element of energy intake and food consumption

Transcription

1 (2006) 60, & 2006 Nture Publishing Group All rights reserved /06 $ ORIGINAL ARTICLE Sncks s n element of energy intke nd food consumption M-L Ovskinen, H Reinivuo, H Tpninen, M-L Hnnil, T Korhonen nd H Pkkl Deprtment of Epidemiology nd Helth Promotion, Nutrition Unit, Ntionl Public Helth Institute, Helsinki, Finlnd Bckground: An incresing frequency of sncks hs been observed in mel pttern studies. Sncks cn lter the diet becuse of their high-energy density nd low-nutrient content or on the contrry. Objective: The prominence of sncks in energy intke nd food consumption ws ssessed. Design: Dietry dt were collected for 2007 dults by using computer-ssisted 48-h dietry recll in the ntionl FINDIET 2002 survey. Energy intkes nd food consumption were ggregted for sncks nd for min mels. Results: Dily energy ws mostly derived from min mels comprising trditionl mixed dishes, milk nd bred. However, snck-dominting mel pttern ws observed in 19% of men nd 24% of women. This mel pttern ws ssocited with urbniztion in both genders nd with physicl work in men. Higher sucrose intke nd lower intke of micronutrients were typicl of the snck-dominting mel pttern compred to the others. Conclusions: As sncks pper to hve higher energy density nd lower content of micronutrients thn min mels, snckdominting mel pttern is indvisble. However, further studies re needed to exmine the ssocition between mel pttern nd helth sttus. (2006) 60, doi: /sj.ejcn ; published online 30 November 2005 Keywords: snck; min mel; eting frequency; energy intke; food consumption Introduction Mels re everydy eting events structured by the frequency of food consumption, by food items pproprite to mel nd even by the order of dishes in the menu (Dougls nd Gross, 1981; Mäkelä, 2000; Poulin, 2002). Eting events hve typiclly been ctegorized s either min mels (structured mels) or sncks (unstructured eting events between mels). These ctegories hve been used in both culturl (Mäkelä, 2000) nd nutritionl studies (Kerney et l., 2001; Poulin, 2002). Trditionlly, nd still in the 1990s, the Europen mel pttern hs been bsed on three Correspondence: Dr M-L Ovskinen, Deprtment of Epidemiology nd Helth Promotion, Nutrition Unit, Ntionl Public Helth Institute, Mnnerheimintie 166, Helsinki, Finlnd. E-mil: mrj-leen.ovskinen@ktl.fi Gurntor: M-L Ovskinen. Contributors: M-LO contributed to study design, nlysis nd writing. HR contributed to dt collection nd writing. HT contributed to dt nlysis nd writing. M-LH contributed to dt nlysis nd writing. TK contributed to study design nd dt collection. HP contributed to study design, dt collection nd writing. Received 28 Jnury 2005; revised 6 September 2005; ccepted 3 October 2005; published online 30 November 2005 min mels, including brekfst (Bellisle et l., 1997; Roos nd Prättälä, 1997; Winkler et l., 1999). In Finlnd nd Sweden, two hot mels per dy hve been more frequent thn in the other Nordic countries (Mäkelä et l., 1999). However, sncks re becoming incresingly populr (Poulin, 2002; Devine et l., 2003) nd my be dded to the diet or consumed in plce of trditionl mels (Bellisle et l., 1997; Poulin, 2002). The concept of sncks is complex; it my comprise confectionery items or beverges only (Andersson nd Rössner, 1996), sncking food (like chips) or even light mels (Poulin, 2002; Chmontin et l., 2003). The effect of sncking on dietry intkes hs been exmined (Longnecker et l., 1997; Roos nd Prättälä, 1997; Poppitt et l., 1998; Legg et l., 2000; Bellisle et l., 2003; Chmontin et l., 2003; Hmpl et l., 2003), but results re contrdictory. The verge dily food consumption nd nutrient intke hve been considered the most relevnt nd chievble estimtes of diets in epidemiologicl studies (Aro et l., 1998; Heitmnn et l., 2000). These pproches, however, neglect the temporl distribution of eting events nd the combintions of food items t ech mel. Food-bsed guidelines for consumers my include preventive messges seprtely for the energy content of mels (Poppitt et l., 1998; Mäkelä,

2 2000; Poulin, 2002). Informtion on food consumption nd energy intke t mels cn be used to develop dietry pln nd to give exmples for recommendtions (Kerney et l., 2001; Ntionl Nutrition Council, 2003; NNR, 2004). In n erlier Finnish study, Roos nd Prättälä (1997) found the number of mels not to be ssocited with either qulity or quntity of ft intke. In other studies, however, incresed mel frequency hs been ssocited with decresed cholesterol concentrtions (Edelstein et l., 1992), body-weight control (Kirk, 2000) nd lso with obesity (Bertéus Forslund et l., 2005). The incresing frequency of sncks hs been shown to correlte positively with totl energy intke (Hmpl et l., 2003). Certin foods like pottoes my be included into the diet only by min mels (Poppitt et l., 1998; Kerney et l., 2001) nd therefore the concept of proper diet is strongly ssocited with min mels (Poulin, 2002). In ddition, under-reporting of food consumption hs incresed in dietry surveys being more frequent with snck-type eting events (Poppitt et l., 1998; Heitmnn et l., 2000; Lfy et l., 2000) nd with vrying number of sncks (Tooze et l., 2004). For these resons, the contribution of sncks to totl energy intke should be scertined. The im of this study ws to exmine the prominence of sncks in the Finnish diet nd to determine which foods re selected for sncks. Moreover, we wnted to estblish the proportion of energy derived by Finnish dult from sncks s opposed to min mels on n verge dy. The socil bckground of persons with snck-dominting mel pttern ws lso studied. Subjects nd methods A cross-sectionl popultion survey (FINRISK 2002) ws crried out in spring 2002 to ssess risk fctors of crdiovsculr diseses (Ltikinen et l., 2003). A rndom smple (n ¼ ) of dults ged yers strtified by sex, region nd 10-yer ge group ws drwn from the popultion register for six regions in Finlnd. Subjects were invited to helth exmintion (including body weight mesurement) t the locl helth cre centre nd sked to complete questionnire covering such bckground informtion s generl hbits, hbitul eting frequency, eduction nd professionl sttus. Subjects in rndom subsmple (n ¼ 3181) from five regions were sked to prticipte in 48-h dietry interview (FINDIET 2002 by Männistö et l., 2003). Of those invited, 64% prticipted, nd 98% of these interviews were subsequently ccepted (n ¼ 2007). The dietry interview covered ll weekdys except Fridys. The FINDIET 2002 dt for ll subjects, including pregnnt (n ¼ 17) nd lctting women, were used in nlyses. Dietry interview protocol Detils of the dietry interview hve been published erlier (Männistö et l., 2003). Dietry dt were collected by Sncks n element of energy nd food intke computerized multiphsed 48-h recll by trined nutritionists. A list of eting events with their times nd plces ws compiled for ech dy. A detiled inventory of ll food items nd in ech eting event followed, strting from the previous dy nd continuing to the dy before yesterdy. The nme, food code, portion size nd dditionl comments on ech food nd beverge were coded immeditely in the dietry dtbse ccording to stndrdized coding rules using inhouse softwre (Männistö et l., 2003). The food composition dtbse included 2100 foods nd composite dishes. Portion sizes were estimted using food models, regulr pckges, household utensils nd picture booklet (Pietinen et l., 1988). A written copy of ech interview ws produced, with prticipnts checking ll informtion t the end of the interview. The Finnish food composition dtbse (KTL, 2002) ws used to clculte energy nd nutrient intkes nd ggregte food consumption. The grouping of individul foods nd beverges ws modified ccording to erlier mel pttern studies (Roos nd Prättälä, 1997; Lfy et l., 2000; Bellisle et l., 2003; Chmontin et l., 2003). Concepts of mel type nd mel pttern Identifiction of ech eting event ws bsed either on the time, the nme or nother description of the eting event given by the subject. According to coding rules, ech eting event, even if it consisted of only cup of coffee, ws identified seprtely ccording to time. In mbivlent cses, the interviewer would clrify the nme during the discussion. The interviewer selected the mel nme from the following lterntives: brekfst, lunch, dinner, drink, evening snck, other snck nd other eting event. To simplify the vriety of mels, mel type ws then divided into two ctegories: min mels nd sncks. Min mels comprised brekfst, lunch nd dinner. All eting events between min mels were considered sncks. Energy intke nd food consumption were ggregted for the two mel types (sncks nd min mels), nd the verge intke over two dys ws clculted. The distribution of men energy intke from sncks nd min mels ws described grphiclly over 24 h in 2-h intervls. To seprte dytime nd evening intkes, cut-off times of 0500 nd 1700 were used (Stroebele nd de Cstro, 2003). Energy density ws defined s energy content per unit weight of food (kj/100 g, Cucó et l., 2001). The verge energy density for sncks nd min mels ws clculted in two wys: for ll foods nd beverges nd for foods nd energy-contining beverges. The difference in men energy intke (kj) between min mels nd sncks ws clculted to enble subjects to be grouped ccording to mel pttern. A negtive difference (energy difference ¼ men energy intke from min mels men energy intke from sncks) ws coded s snck-dominting mel pttern. Dily nutrient intke ws used to describe the diet by mel pttern. Bckground fctors nd lso the hbitul frequency 495

3 Sncks n element of energy nd food intke 496 of eting events from the bckground questionnire were used s explntory vribles for snck-dominting mel pttern. Tble 1 Chrcteristics of FINDIET 2002 prticipnts Men Women n (%) n (%) Sttisticl methods Food items were ggregted into 17 food groups to describe proportion of consumers by food group nd to clculte the men food consumption (g/dy). In ddition, the men contribution of food groups to the energy content of sncks nd min mels ws determined. Anlysis of vrince ws used to ssess the difference in dietry intke between genders, the difference in energy density between mel types (within-subject effect) nd the difference in nutrient intke between mel ptterns for both genders. The dy-to-dy correltion coefficients for energy intkes were produced with the mixed liner model. A logistic regression model ws used to nlyse the ssocition between bckground fctors nd the snckdominting mel pttern. The regions were ggregted s Southern Finlnd (including the cpitl region of Helsinki nd Turku with its surroundings) nd Northern Finlnd (including North-Kreli, Oulu nd Northern Svo). The dt were nlysed using the SAS sttisticl pckge (SAS, 1999). All nlyses were performed seprtely for men nd women. Results Bckground fctors nd degree of obesity of FINDIET 2002 prticipnts re presented in Tble 1. The proportions of persons ccording to different eting event per dy re lso presented (Tble 1). Almost ll prticipnts hd brekfst on t lest one dy (93% of men, 97% of women). Bsed on 48-h dietry reclls, Finnish men hd n verge of 6.0 (s.e. 0.05) nd women 6.1 (s.e. 0.05) eting events per dy. The men (s.e.) number of sncks ws 3.7 (0.05) in men nd 3.8 (0.05) in women. The verge dily energy intke nd ft content (s energy %) of the diet were higher in men thn in women (Tble 2). Sucrose content ws, however, higher in the women s diet. The 24-h energy intke is displyed grphiclly in Figure 1. The energy intke from min mels hd two peks, t lunch nd t dinner. Energy from sncks ws minly obtined during the evenings nd nights. During the dytime energy ws mostly derived from min mels, both for men nd women (Figures 1 nd 2). Prticipnts reported consumption of 1554 different food items, nd the men number of dily food items consumed ws 25 (rnge 3 49). The following food groups were represented in sncks for t lest hlf of the Finnish dults: coffee or te, milk products, bred, wter, sweets, met or fish, fts, sweet bkery goods nd fruit or fresh vegetbles (Tble 3). Totl n 912 (100) 1095 (100) Age yers 190 (21) 263 (24) yers 722 (79) 832 (76) Region Southern Finlnd 334 (37) 416 (38) Northern Finlnd 578 (63) 679 (62) Professionl sttus Nonmnul worker, student 417 (46) 715 (65) Mnul worker, frmer 274 (30) 95 (9) Retired, unemployed, housewife 213 (23) 269 (25) Missing 8 (1) 16 (1) Body mss index (BMI kg/m 2 ) o25 (norml weight) 286 (31) 531 (48) (overweight) 426 (47) 354 (32) 430 (obese) 200 (22) 210 (19) Persons ccording to different eting events on t lest 1 of 2 dys in the 48-h dietry recll Brekfst 846 (93) 1057 (97) Lunch 791 (87) 975 (89) Dinner 716 (79) 810 (74) Drink 765 (84) 851 (78) Evening snck 770 (84) 972 (89) Other snck 833 (91) 1062 (97) Other eting event 40 (4) 85 (8) Tble 2 Dietry intkes in FINDIET 2002 study popultion Men Women F-vlue (df1, df2) (n ¼ 912) (n ¼ 1095) Men (s.e.) Men (s.e.) Energy intke, MJ/dy b 9.16 (0.09) 6.62 (0.06) (1,1994) Ft content of the diet, E% 34.9 (0.3) 32.4 (0.2) b 47.8 (1,1991) Sucrose content of the diet, E% 9.1 (0.2) 10.8 (0.1) b 51.5 (1,1991) Detiled informtion published erlier (Männistö et l., 2003). b Po for the difference between genders in nlysis of vrince models; other explntory vribles re ge nd region. Most energy intke t sncks ws derived from sweet bkery goods (14%), bred (14%), lcoholic beverges (13%) nd milk products (12%) in men, nd sweet bkery goods (18%), bred (14%), milk products (12%) nd sweets nd chocolte (19%) in women (Tble 4). At min mels, met nd fish dishes, pottoes nd cooked vegetbles contributed to energy intke. The energy density (kj/100 g) of foods nd energy-contining beverges ws higher in sncks thn in min mels (Tble 5). The dy-to-dy correltion coefficient for snck energy intkes ws 0.19 in men nd 0.37 in women, while for totl energy intkes it ws 0.25 in both genders.

4 Sncks n element of energy nd food intke Tble 3 Description of sncks in Finnish dults (FINDIET 2002): proportions of consumers nd men consumption of selected food groups 497 Food group Men (n ¼ 912) Women (n ¼ 1095) Consumers % Men Consumers Men consumption % consumption g/dy (s.e.) g/dy (s.e.) Figure 1 Men energy intke in 2-h time blocks contributed by sncks nd min mels in Finnish dults. MEN, totl Coffee nd Te (11.8) (7.7) Milk products (5.4) (4.0) Bred (1.8) (1.2) Wter (13.4) (13.9) Sweets, chocolte (0.9) (0.9) Met or fish (1.9) (1.0) Fts nd dressing 61 9 (0.5) 57 6 (0.3) Sweet bkery goods (1.5) (1.1) Fruit, fresh vegetbles (4.3) (4.0) Juice (5.3) (4.4) Alcoholic beverges (18.3) (5.0) Puddings, berry (2.1) (1.8) soups Pizz, burger, psty (1.3) (0.9) Soft drinks (5.4) (3.1) Pst, rice, porridge (1.4) (1.3) Potto, cooked 12 7 (0.8) 14 6 (0.7) vegetbles Slty sncking foods 7 2 (0.4) 11 2 (0.3) Order dictted by the proportion of men s consumers. Dytime Evening WOMEN, totl Dytime Evening Energy intke (MJ/dy) Figure 2 Men energy intke (95% confidence intervl) contributed by sncks nd min mels in the dytime nd in the evening in Finnish dults (filled circles min mels, open circles sncks). Mel ptterns were identified by the difference in men energy intke (kj) between min mels nd sncks. A negtive difference indicted higher energy intke from sncks nd ws recorded s snck-dominting mel pttern (Figure 3). One fifth of men nd one fourth of women were Tble 4 Contribution (%) of selected food groups to energy intkes t sncks nd min mels (FINDIET 2002) Food group Men (n ¼ 912) Women (n ¼ 1095) Sncks Min mels Sncks Min mels Energy (%) Energy (%) Energy (%) Energy (%) Sweet bkery goods Bred Alcoholic beverges Milk products Met or fish Sweets, chocolte Fts nd dressings Pizz, burger, psty Puddings, berry soup Fruit, fresh vegetbles Juice Pst, rice, porridge Soft drinks Slty sncking foods Coffee nd te Potto, cooked vegetbles Wter Totl Food group contributing to energy intke t sncks. found to hve snck-dominting mel pttern. In men, dily energy intke ws higher in those with snckdominting mel pttern thn in the others (Tble 6). Dily

5 498 Tble 5 Sncks n element of energy nd food intke Energy intke nd energy densities of sncks nd min mels Men (n ¼ 912) Women (n ¼ 1095) Sncks Min mels Sncks Min mels Men (s.e.) Men (s.e.) F-vlue (df1, df2) Men (s.e.) Men (s.e.) F-vlue (df1, df2) Totl energy intke, kj 3305 (68) 5854 (74) 569 (1,904) Energy density of foods nd energy-contining 532 (9) 483 (4) 24 (1,886) beverges, kj/100 g Energy density of foods nd beverges, kj/100 g 231 (3) 359 (3) 994 (1,889) 2632 (45) 3987 (46) 413 (1,1081) 522 (8) 436 (3) 131 (1,1082) 203 (3) 293 (3) 693 (1,1082) Po in repeted mesures nlysis of vrince models. Mel type is within-subject effect, nd region nd ge group re between-subject effects Mles Femles chnged the determinnts of the snck-dominting mel pttern. Discussion Difference in energy intke (MJ) Figure 3 Empiricl density function of Finnish dults for the difference in energy intke between min mels nd sncks (energy difference (MJ) ¼ men energy from min mels (MJ) men energy from sncks (MJ)). Negtive vlue for the difference in energy intke ¼ snck-dominting mel pttern. nutrient intkes were given s bsolute intkes, nd in terms of intke per energy unit. Both men nd women with snck-dominting mel pttern hd higher intkes (/MJ) of lcohol, sugrs nd sucrose nd lower intke of severl micronutrients (Tble 6). Sodium content of the diet ws lso lower for those with snck-dominting mel pttern thn the others. Determinnts of the snck-dominting mel pttern were region of residence in both men nd women, professionl sttus in men nd ge in women (Tble 7). This mel pttern ws more typicl in the southern thn in the northern regions of Finlnd for both genders nd ws more frequent mong mle mnul workers nd frmers thn mong mle nonmnul workers. The snck-dominting mel pttern ws more prevlent in younger women thn in older women. Neither self-reported number of hbitul dily mels (dt from bseline questionnire) nor eduction Min mels in the 2000s re still the primry source of dietry energy, consistent with previous observtions mde in Finlnd (Roos nd Prättälä, 1997; Mäkelä, 2000) nd elsewhere (Winkler et l., 1999; Kerney et l., 2001; Poulin, 2002; Bellisle et l., 2003). More energy (36% in men, 40% in women, Tble 4) is now, however, derived from sncks thn previously reported (33% in both men nd women, Roos nd Prättälä, 1997). This result implies tendency for higher contribution of energy intke from sncks. The snck-dominting mel pttern ws introduced in this study to indicte the reltively lrger energy intke derived from sncks thn from min mels. This mel pttern ws observed in one-fifth of men nd one-fourth of women, nd it ws more typicl in urbn Southern Finlnd thn in the other study regions. New food trends hve usully strted in Southern Finlnd (Roos nd Prättälä, 1997), where the vilbility of different foods nd dining plces is much wider thn elsewhere. Poulin (2002) hs erlier reported simplified eting events to be prevlent in urbn popultions, prticulrly mong femles nd white-collr workers. Conversely, in our study, the snck-dominting mel pttern ws more frequent in mle mnul workers nd frmers thn in mle nonmnul workers. A snck-dominting mel pttern my be cused mong mle mnul workers by irregulr working times, the lck of work cnteens nd lrger energy requirements. Consistent with this, hving lunch t workplce cfeteri hs been demonstrted to be ssocited with higher eduction in employed Finnish dults (Rulio et l., 2005). Food consumption nd food items t min mels nd t sncks my differ by country. We found the energy contribution from sweet bkery goods, other sweets nd chocolte nd lcoholic beverges to be higher in sncks thn in min mels, finding lso reported by Bellisle et l. (2003). In Frnce, by contrst, te nd coffee were more typicl t min mels thn t sncks, while milk products were s typicl t mels s in Finlnd. Culturl trditions

6 Sncks n element of energy nd food intke Tble 6 Nutrient content of the diet by mel pttern, men (s.e.) 499 Men Women Min mel-dominting diet n ¼ 741 Snck-dominting diet n ¼ 171 Min mel-dominting diet n ¼ 829 Snck-dominting diet n ¼ 266 Energy, MJ 9.02 (0.10)** 9.77 (0.25)** 6.56 (0.07) 6.80 (0.14) Energy of foods, MJ 8.89 (0.09) (0.21) (0.07) (0.14) 0 Ft, g 86.8 (1.3) 88.8 (2.9) 58.4 (0.8) 60.1 (1.7) Ft, g/mj 9.50 (0.07)* 9.08 (0.19)* 8.78 (0.07) 8.71 (0.13) Protein, g 87.2 (1.1) 83.1 (2.1) 64.2 (0.7)** 60.4 (1.3)** Protein, g/mj 9.77 (0.07)** 8.76 (0.17)** 9.93 (0.07)** 9.07 (0.14)** Crbohydrtes, g (2.9)* (6.7)* (2.1)* (4.2)* Crbohydrtes, g/mj 26.5 (0.2) 26.2 (0.4) 28.5 (0.2)* 29.1 (0.3)* Alcohol, g 8.3 (0.7)** 25.9 (4.2)** 3.0 (0.3)** 5.2 (0.8)** Alcohol, g/mj 0.87 (0.06)** 2.24 (0.30)** 0.43 (0.04)** 0.72 (0.1)** Vitmin C, mg 95.3 (2.9)** 74.3 (5.0)** (2.5) 99.6 (4.0) Vitmin C, mg/mj 11.0 (0.3)** 8.4 (0.6)** 17.2 (0.4) 16.1 (0.7) Vitmin A, mg 1082 (61) 854 (50) 948 (41) 858 (56) Vitmin A, mg/mj 122 (6)* 92 (6)* 151 (7) (7) 0 Vitmin E, mg (0.21) (0.39) 9.06 (0.16) (0.23) 0 Vitmin E, mg/mj 1.34 (0.02)** 1.18 (0.04)** 1.39 (0.02)** 1.27 (0.03)** Vitmin D, mg 5.84 (0.23) 5.49 (0.43) 3.90 (0.15) 3.29 (0.19) Vitmin D, mg/mj 0.65 (0.02) 0.61 (0.06) 0.61 (0.02) 0.50 (0.03) Fibre, g (0.38) (0.81) (0.28) (0.48) Fibre, g/mj 2.52 (0.04)** 2.17 (0.09)** 2.94 (0.04) 2.71 (0.07) Sugrs, g (1.8)** (4.8)** 85.8 (1.3)** 98.7 (2.7)** Sugrs, g/mj 11.3 (0.1)** 12.7 (0.4)** 13.0 (0.1)** 14.6 (0.3)** Sucrose, g 47.3 (1.1)** 58.0 (3.1)** 40.8 (0.8)** 49.8 (1.9)** Sucrose, g/mj 5.18 (0.10)** 6.01 (0.31)** 6.07 (0.10)** 7.13 (0.19)** Clcium, mg 1196 (22) 1148 (41) 966 (14) 986 (27) Clcium, mg/mj 133 (2)** 121 (4)** 150 (2) 147 (3) Potssium (K), mg 4044 (44)* 3794 (87)* 3225 (32)* 3059 (52)* Potssium (K), mg/mj 462 (4)** 404 (8)** 508 (4)** 473 (8)** Sodium (N), mg 3992 (52)* 3636 (92)* 2764 (32)** 2544 (53)** Sodium (N), mg/mj 448 (4)** 385 (9)** 429 (4)** 383 (6)** Iron, mg (0.21) (0.38) (0.14) 9.7 (0.2) Iron, mg/mj 1.51 (0.02)** 1.33 (0.04)** 1.57 (0.02)** 1.45 (0.02)** Mgnesium, mg (4.6) (11.2) (3.2) (5.3) Mgnesium, mg/mj 45.9 (0.4)** 43.0 (0.8)** 48.7 (0.4) 46.7 (0.7) 0 /*/**P-vlue / /o0.01 for the difference between mel ptterns in nlysis of vrince model; other explntory vribles were ge nd re. obviously ply role in the food consumption t mels nd mel rules my be more stble in some food cultures (Poulin, 2002; Bellisle et l., 2003) thn in the Finnish or British (Chmontin et l., 2003) food culture. Min courses with met or fish, stple food nd vegetbles were typicl of min mels in Finlnd, similr to min mels in Frnce (Poulin, 2002). Women (more so thn men) in Finlnd preferred fruit nd fresh vegetbles lso for sncks, consistent with reports in some other cultures (Kerney et l., 2001; Bellisle et l., 2003; Devine et l., 2003). The energy density (MJ/100 g) of ll foods nd energycontining beverges eten t sncks ws higher thn tht of min mels. However, lower intkes of micronutrients were observed in persons with snck-dominting mel pttern

7 500 Tble 7 Odds rtios for snck-dominting mel pttern in 48-h dietry reclls of Finnish dults by logistic regression model Men (n ¼ 912) OR (95% CI) Women (n ¼ 1095) OR (95% CI) Age Older (35 64 yers) Younger (25 34 yers) 1.06 ( ) 1.41 ( ) Region Northern Finlnd Southern Finlnd 1.60 ( ) 1.43 ( ) Professionl sttus Nonmnul worker, student Mnul worker, frmer 1.52 ( ) 0.96 ( ) Retired, unemployed, housewife, other 1.01 ( ) 0.78 ( ) Totl model Younger vs older 1.04 ( ) 1.38 ( ) Southern vs Northern 1.71 ( ) 1.46 ( ) Mnul worker, frmer vs 1.68 ( ) 1.04 ( ) nonmnul worker, student Retired, unemployed, housewife vs nonmnul worker, student 1.12 ( ) 0.86 ( ) Adjusted for verge dily energy intke. Sncks n element of energy nd food intke compred with the others, which supports erlier results regrding the composition of sncks (Roos nd Prättälä, 1997; Poppitt et l., 1998; Lennernäs nd Andersson, 1999; Stroebele nd de Cstro, 2003). Although, intke differences were slight, the ssocitions between snck-dominting mel pttern nd helth sttus wrrnt further studies. Mel identifiction cn be bsed on subjects descriptions of the eting event, s in this study nd in some previous reports (Winkler et l., 1999; Legg et l., 2000; Bellisle et l., 2003; Bertéus Forslund et l., 2005). Other possibilities for identifying mel type hve been bsed on the food composition of the mel (Andersson nd Rössner, 1996; Lennernäs nd Andersson, 1999; Poulin, 2002) or on the mounts consumed (Legg et l., 2000). In n erlier Finnish study (Roos nd Prättälä, 1997), for exmple, brekfst with wrm dish ws included in min mels, but brekfst composed of beverges only ws included in sncks. We did not use informtion bout food composition of mels to define mel types in this study. Defining brekfst s min mel my thus led to n underestimtion in the number of sncks nd in the energy intke from sncks. On the other hnd, foods eten in the evenings more often being defined s n evening snck my led to n overestimtion in the energy intke from sncks becuse distinguishing between n evening snck nd lte dinner is not lwys possible. The difficulty in discriminting light mels from sncks hs lso been reported in other studies (Bertéus Forslund et l., 2002; Poulin, 2002; Chmontin et l., 2003; Devine et l., 2003). This study used quntittive dt collected by 48-h dietry reclls (two 24 h reclls) for mel pttern nlyses (Lfy et l., 2000; Mäkelä, 2000). The number of dily eting events ws higher (bout six) thn figures reported in erlier studies in Finlnd (Roos nd Prättälä, 1997; Mäkelä et l., 1999) or in other countries (Longnecker et l., 1997; Winkler et l., 1999; Bellisle et l., 2003). Similr dily frequencies hve been reported only in Sweden (Andersson nd Rössner, 1996; Bertéus Forslund et l., 2002). The multiphse interviewing procedure used here enbled complete reclling of eting events during the 2 dys. However, hbitul mel frequency cnnot be estimted well with only two dys of dietry reclls even for those with regulr mel pttern (Longnecker et l., 1997; Roos nd Prättälä, 1997; Buzzrd, 1998). When we controlled for the effect of hbitul mel frequency (from generl hbits in the bseline questionnire) it confirmed the result of snck-dominting mel pttern. Thus, the method of 48-h dietry recll proved to be sufficient for mel pttern nlysis. The effects of weekdys nd working sttus on mel frequency of interviewed dys were not studied here. While the number of eting occsions in this study my be ccurte, the mounts or the number of food items my be under-reported. Legg et l. (2000) noted tht the sizes of mels (especilly brekfsts) over severl dys correlted modertely, but totl intkes vried gretly. Two consecutive study dys, s used here, my therefore hve interdependencies with the number of eting events nd the types of foods consumed (Longnecker et l., 1997; Lfy et l., 2000; Legg et l., 2000). Vrition in the diet my be underestimted for this reson, s well s becuse informtion on sesonl differences ws missing. Under-reporting of sncks, prticulrly for those hving frequent sncks (Tooze et l., 2004), hs been found to be more common thn under-reporting of min mels (Bellisle et l., 1997; Poppitt et l., 1998; de Cstro, 2000; Lfy et l., 2000). Coverge of sncks in the interviewing procedure should therefore be controlled with n dequte number of questions nd memory ids (Buzzrd, 1998). Differences between prticipnts nd nonprticipnts hve been studied in erlier FINRISK surveys (Jousilhti et l., 2005). The study popultion here represented 64% of persons invited, nd nonprticiption hs previously shown to be ssocited with high mortlity (Jousilhti et l., 2005). Thus, the poor prticiption probbly limits the generliztion of our results. We found differences in snckdominting mel pttern by ge only for women, lthough irregulr eting events re typicl of young dults in both sexes (Kerney et l., 2001). Modern sedentry lifestyle combined with more eting events (Bertéus Forslund et l., 2002) my led to excessive weight, but the evidence hs thus fr been wek (Bellisle et l., 1997) or nonexistent (Hmpl et l., 2003). Restrined eting hs not been noted (Legg et l., 2000) to ffect energy intkes of sncks nd min mels differently. In n erlier study (Hmpl et l., 2003), multiple-snckers were observed to consume more energy

8 thn never-snckers. The ssocitions between frequent sncks, lifestyle, helth sttus, obesity nd dietry restrint wrrnt further studies. In conclusion, snck-dominting mel pttern is incomptible with nutrition recommendtions (NNR, 2004) due to selection of nutrient-poor food items. References Andersson I, Rössner S (1996). Mel ptterns in obese nd norml weight men: The Gustf study. Eur J Clin Nutr 50, Aro A, Pietinen P, Vlst L, Turpeinen A, Ehnholm C, Dougherty RM et l. (1998). Effects of reduced-ft diets with different ftty cid compositions on serum lipoprotein lipids nd polipoproteins. Public Helth Nutr 1, Bellisle F, Dlix A, Mennen L, Gln P, Hercberg S, de Cstro JM et l. (2003). Contribution of sncks nd mels in the diet of French dults: diet-diry study. Phys Behv 79, Bellisle F, McDevitt R, Prentice A (1997). Mel frequency nd energy blnce. Br J Nutr 77 (Suppl 1), S57 S70. Bertéus Forslund H, Lindroos A, Sjöström L, Lissner L (2002). Mel pttern nd obesity in Swedish women simple instrument describing usul mel types, frequency nd temporl distribution. Eur J Clin Nutr 56, Bertéus Forslund H, Torgerson J, Sjöström L, Lindroos A (2005). Sncking frequency in reltion to energy intke nd food choices in obese men nd women compred to reference popultion. Int J Obes Relt Metb Disord 29, Buzzrd M (1998). 24-h dietry recll nd food record methods. In: W Willett (ed.), Nutritionl epidemiology. New York: Oxford University Press, pp Chmontin A, Pretzer G, Booth D (2003). Ambiguity of snck in British usge. Appetite 41, Cucó G, Arij V, Mrtí-Heneberg C, Fernández-Bllrt J (2001). Food nd nutritionl profile of high energy density consumers in n dult Mediterrnen popultion. Eur J Clin Nutr 55, de Cstro J (2000). Eting behvior: lessons from the rel world of humns. Nutrition 16, Devine C, Connors M, Sobl J, Bisogni C (2003). Sndwiching it in: spillover of work onto food choices nd fmily roles in low- nd moderte-income urbn households. Soc Sci Med 56, Dougls M, Gross J (1981). Food nd culture: Mesuring the intriccy of rule systems. Soc Sci Inform 20, Edelstein S, Brrett-Connor E, Wingrd D, Cohn B (1992). Incresed mel frequency ssocited with decresed cholesterol concentrtions; Rncho Bernrdo, CA, Am J Clin Nutr 55, Hmpl J, Heton C, Tylor C (2003). Sncking ptterns influence energy nd nutrient intkes but not body mss index. J Humn Nutr Dietet 16, Heitmnn B, Lissner L, Osler M (2000). Do we et less ft, or just report so? Int J Obes 24, Jousilhti P, Slom V, Kuulsm K, Niemelä M, Vrtiinen E (2005). Totl nd cuse specific mortlity mong prticipnts nd non-prticipnts of popultion bsed helth surveys: comprehensive follow up of Finnish men nd women. J Epidemiol Community Helth 59, Kerney J, Hulshof K, Gibney M (2001). Eting ptterns temporl distribution, converging nd diverging foods, mels eten outside nd inside of the home implictions for developing FBDG. Public Helth Nutr 4, Sncks n element of energy nd food intke Kirk T (2000). Role of dietry crbohydrte nd frequent eting in body-weight control. Proc Nutr Soc 59, KTL (Ntionl Public Helth Institute) (2002). Nutrition Unit. Finnish food composition dtbse Fineli s (version 2). Ltest version t Ltikinen T, Tpninen H, Alfthn G, Slminen I, Sundvll J, Leiviskä J et l. (2003). FINRISK Survey implementtion nd results 1. Helsinki: Publictions of the Ntionl Public Helth Institute Report No B7/ pdf. Lfy L, Mennen L, Bsdevnt A, Chrles M, Borys J, Eschwège E, et l., the FLVS study group (2000). Does energy intke underreporting involve ll kinds of food or only specific food items? Results from the Fleurbix Lventie Ville Snté (FLVS) study. Int J Obes 24, Legg C, Puri A, Thoms N (2000). Dietry restrint nd self-reported mel sizes: diry studies with differentilly informed consent. Appetite 34, Lennernäs M, Andersson I (1999). Food-bsed clssifiction of eting episodes (FBCE). Appetite 32, Longnecker M, Hrper J, Kim S (1997). Eting frequency in the ntionwide food consumption survey (USA), Appetite 29, Mäkelä J (2000). Culturl definitions of the mel. In: H Meiselmn (ed.), Dimensions of the Mel. Githersburg: Aspen Publishers Inc., pp Mäkelä J, Kjærnes U, Ekström M, L orngé Fürst E, Gronow J, Holm L (1999). Nordic mels: Methodologicl notes on comprtive survey. Appetite 32, Männistö S, Ovskinen M-L, Vlst L (eds) (2003). The ntionl Findiet 2002 study. Publictions of the Ntionl Public Helth Institute Report No B3/2003 (in Finnish, with English tbles, figures nd summries) b3. Ntionl Nutrition Council (2003). Action progrm for implementing ntionl nutrition recommendtions (in Finnish with n English bstrct). Ministry of Agriculture nd Forestry, Helsinki. NNR (Nordic Nutrition recommendtions) (2004). Nord 2004;13. Copenhgen: Nordic Council of Ministers. Pietinen P, Hrtmn A, Hp E, Räsänen L, Hpkoski J, Plmgren J et l. (1988). Reproducibility nd vlidity of dietry ssessment instruments. I. A self-dministered food use questionnire with portion size picture booklet. Am J Epidem 128, Poppitt S, Swnn D, Blck A, Prentice A (1998). Assessment of selective under-reporting of food intke by both obese nd nonobese women in metbolic fcility. Int J Obes 22, Poulin J (2002). The contemporry diet in Frnce: de-structurtion or from commenslism to vgbond feeding. Appetite 39, Rulio S, Roos E, Rhkonen O, Prättälä R (2005). Twenty-yer trends of workplce lunches in Finlnd. Food Service Technol 5, (in press). Roos E, Prättälä R (1997). Mel ptterns nd nutrient intke mong dult Finns. Appetite 29, SAS (1999). Sttisticl pckge, Version 8.2. Gry, N.C: SAS Institute Inc. Stroebele N, de Cstro J (2003). Television viewing is ssocited with n increse in mel frequency in humn. Appetite 42, Tooze J, Subr A, Thompson F, Troino R, Schtzkin A, Kipnis V (2004). Psychosocil predictors of energy underreporting in lrge double lbeled wter study. Am J Clin Nutr 79, Winkler G, Döring A, Keil U (1999). Mel ptterns in middle-ged men in Southern Germny: results from the MONICA Augsburg dietry survey 1984/85. Appetite 32,