Association of Snacking Frequency, Size, and Energy Density with Weight Status among Preschool-Aged Children in the United States

Background Snacking (ie, eating between meals) is common among US preschool-aged children, but associations with weight status are unclear.Objective This research evaluated associations of snack frequency, size, and energy density as well as the percent of daily energy from snacking with weight status and sociodemographic characteristics among US children aged 2 to 5 years.Design Cross-sectional analysis of 2007-2018 National Health and Nutrition Exami-nation Survey data using two, caregiver proxy, 24-hour dietary recalls.Participants/setting US children aged 2 to 5 years (n 1/4 3,313) with at least one snack occasion over 2 days of intake. Main outcome measures Snacking parameters included frequency (number of occa-sions per day), size (kilocalories per occasion), and energy density (kilocalories per gram per occasion) as well as percent of daily energy from snacking.Statistical analyses Generalized linear regression models evaluated associations of snacking with child weight status (ie, normal weight and overweight/obesity), adjusting for survey weights, energy misreporting, mean meal size, and sociodemographic covariates.Results Children with overweight/obesity consumed more frequent snacks (2.8 [0.06] vs 2.5 [0.03] snacks/day, respectively; P < 0.001), larger snacks (188 [4] vs 162 [23] kcal/ occasion, respectively; P < 0.001), and a greater percent of daily energy from snacking (29.80% [1.0 0%] vs 26.09% [0.40%], respectively; P < 0.001) than children with normal weight. Mean snack frequency and size as well as percentage of daily energy from snacking varied with child age, gender, and head of household education. Associations of snacking with child race and ethnicity were less consistent.Conclusions These nationally representative findings provide evidence that the con-sumption of larger, more frequent snacks is associated with overweight/obesity among US children aged 2 to 5 years and snacking varies by sociodemographic characteristics. J Acad Nutr Diet. 2023;123(2):309-317.