Public Health Nutrition

Research Papers

The role of eating frequency on total energy intake and diet quality in a low-income, racially diverse sample of schoolchildren

E Whitney Evansa1 c1, Paul F Jacquesa2a3, Gerard E Dallala2a3, Jennifer Sachecka2 and Aviva Musta2a4

a1 Weight Control and Diabetes Research Center, Brown University School of Medicine, 196 Richmond Street, Providence, RI 02903, USA

a2 Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

a3 Jean Mayer–USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA

a4 School of Medicine, Tufts University, Boston, MA, USA


Objective The relationship of meal and snacking patterns with overall dietary intake and relative weight in children is unclear. The current study was done to examine how eating, snack and meal frequencies relate to total energy intake and diet quality.

Design The cross-sectional associations of eating, meal and snack frequencies with total energy intake and diet quality, measured by the Healthy Eating Index 2005 (HEI-2005), were examined in separate multivariable mixed models. Differences were examined between elementary school-age participants (9–11 years) and adolescents (12–15 years).

Setting Two non-consecutive 24 h diet recalls were collected from children attending four schools in the greater Boston area, MA, USA.

Subjects One hundred and seventy-six schoolchildren, aged 9–15 years.

Results Overall, 82 % of participants consumed three daily meals. Eating, meal and snack frequencies were statistically significantly and positively associated with total energy intake. Each additional reported meal and snack was associated with an 18·5 % and a 9·4 % increase in total energy intake, respectively (P<0·001). The relationships of eating, meal and snack frequencies with diet quality differed by age category. In elementary school-age participants, total eating occasions and snacks increased HEI-2005 score. In adolescents, each additional meal increased HEI-2005 score by 5·40 points (P=0·01), whereas each additional snack decreased HEI-2005 score by 2·73 points (P=0·006).

Conclusions Findings suggest that snacking increases energy intake in schoolchildren. Snacking is associated with better diet quality in elementary school-age children and lower diet quality in adolescents. Further research is needed to elucidate the role of snacking in excess weight gain in children and adolescents.

(Received June 21 2013)

(Revised January 20 2014)

(Accepted February 04 2014)

(Online publication April 29 2014)


  • Childhood obesity;
  • Meal patterns;
  • Snack patterns;
  • Energy intake;
  • Diet quality


c1 Corresponding author: Email