Chapter 27 - Snacking and Energy Balance in Humans

A person's daily nutrient intake and overall nutritional status are determined by a complex interplay of the types and amounts of foods ingested in combination with the timing and frequency of eating.

The aim was to summarize frequency of eating occasion data examined by the 2020 Dietary Guidelines Advisory Committee, the macronutrient contributions they provide, and meal frequency relative to dietary quality among the US population (≥2 y), with a focus on sex, age, race/Hispanic origin, and income.

Demographic and 24-h recall data from the 2013–2016 NHANES were examined. An eating occasion was defined as “any ingestive event (e.g., solid food, beverage, water) that is either energy yielding or non-energy yielding”; all eating occasions were further divided into discrete meals and snacks. Frequency of meals and snacks was defined as “the number of daily EOs [eating occasions],” respectively. Diet quality was assessed via the Healthy Eating Index (HEI)–2015.

Most Americans consume 2 (28%) to 3 (64%) meals on a given day and >90% consume 2 to 3 snacks on that day. Adult, Hispanic, and non-Hispanic Black and lower-income (<131% family poverty-to-income ratio) Americans had a lower frequency of eating than children or adolescents, non-Hispanic White, and non-Hispanic Asian Americans and higher-income Americans, respectively. Americans who reported 3 meals on a given day consumed a diet higher in dietary quality than Americans who consumed 2 meals on a given day (HEI-2015: 61.0 vs. 55.0), regardless of population subgroup.

The frequency of the types of eating occasions differs according to age, race and Hispanic origin, and income. Dietary quality is associated with the number of meals consumed. Healthy dietary patterns can be constructed in a variety of ways to suit different life stages, cultural practices, and income levels; improved diet quality and careful consideration of nutrient density when planning meals are warranted.

Energy intake is the product of portion size (PS)—the energy content of an ingestive event—and ingestive frequency (IF)—the number of ingestive events per unit time. An uncompensated alteration in either PS or IF would result in a change in energy intake and body weight if maintained over time. The objective of this meta-analysis was to assess the independent effects of PS and IF on energy intake and body weight among healthy adults in randomized controlled trials (RCTs). A total of 9708 articles were identified in PubMed, Web of Science, Cochrane, and CINAHL databases. The articles were divided among 10 researchers; each article was screened for eligibility by 2–3 independent reviewers. Exclusion criteria included: populations <19 y and >65 y, unhealthy populations (i.e. participants with an acute or chronic disease), assessments <24 h and <4 wk in duration for trials investigating energy intake or body weight, respectively. Controlled feeding trials (i.e. fixed energy intake) that manipulated IF and PS in the same study intervention (IF/PS) were evaluated separately and for the body weight outcome only. Twenty-two studies (IF = 4, PS = 14, IF/PS = 4) met the inclusion criteria. There was an insufficient number of studies to assess the effect of IF, PS, or IF/PS on body weight. There was heterogeneity in the effect sizes among all comparisons (I² ≥75%). Consuming larger portion sizes was associated with higher daily energy intake [295 kcal (202, 388), n = 24; weighted mean differences (WMD) (95% CI), n = comparisons], and increased frequency of ingestive events was associated with higher energy intake [203 kcal (76, 330), n = 10]. Results from RCTs support that larger PS and greater IF are both associated with higher energy consumption. However, there is insufficient information to determine chronic effects on body weight. This protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42018104757.

The prevalence of snacking has increased over the past decades. These trends have been implicated in the incidence and prevalence of overweight/obesity. This chapter begins with a description of snacking dimensions and definitions. It then summarizes the current prevalence of snacking and how it impacts on energy balance. This chapter highlights that snacking is associated with both beneficial/neutral and negative effects on energy balance. Numerous methodological issues could explain discrepancies between studies investigating the impact of snacking on energy balance. These include snacking definitions and assessments, timing, food quality, food perceptions, attention while snacking, underreporting, and lifestyle habits. Although more intervention studies are needed to clarify the impact of snacking on energy balance, the literature supports the view that healthy snacking can be part of a healthy lifestyle without promoting body weight gain. The chapter concludes with consideration and recommendation on how snacking can be incorporated into a healthy diet.

Large portion sizes are frequently blamed for the obesity epidemic. In this paper, we examine the culpability of large portion sizes. It is true that portion sizes have increased during the obesity epidemic, but there is as yet little evidence that exposure to large portions produces significant weight gain. Furthermore, some evidence argues against the role of large portions in the obesity epidemic. For instance, the epidemic is largely a matter of weight gain among the upper half of the population weight distribution, whereas large portions appear to have an indiscriminate effect on food intake. Factors other than the size of individual meals may well be responsible for a great deal of the observed population weight gain.

Energy intake is a function of the quantity of energy consumed per ingestive event and the number of these events. The marked increase of energy intake and body weight over the past 35 years indicates that there has been poor precision in the reciprocity of these two facets of intake. With recent study of the associations between gut “satiation” peptides and energy intake, there has been an emphasis on the contribution of portion size to positive energy balance. However, this orientation may not appropriately weight the contribution of ingestive frequency. Gut peptides are not purely satiation factors and metabolic and environmental cues may more strongly guide the onset and number of ingestive events. Evidence is presented that while both portion size and ingestive frequency have increased in the population, the latter may be more problematic for weight gain. The magnitude and time course of increments in ingestive frequency map better onto energy intake and BMI trends than changes of portion size. This may occur, in part, because dietary compensation and thermogenic effects are weaker for increases in ingestive frequency than portion size. Though not to the exclusion of consideration of portion size effects, improved weight management may be achieved with greater attention to the drivers of eating and drinking frequency.