title: Increased Snacking and Eating Occasions Are Associated with Higher Energy Intake among Mexican Children Aged 2-13 Years.
abstract: BACKGROUND
  Little is known about the dietary behaviors of Mexican children with regard to frequency, amount, and quality of foods consumed at eating occasions and their impact on total daily energy intake.
  
  
  OBJECTIVE
  The objectives were to 1) describe foods consumed across eating occasions and 2) examine whether the number or type of total eating occasions was associated with increased total daily energy intake and differed between 2- to 5-y-old and 6- to 13-y-old Mexican children.
  
  
  METHODS
  A nationally representative sample of 5031 children from the 2012 ENSANUT (Encuesta Nacional de Salud y Nutrición) was used to examine the percentage of meals and snacks consumed, mean energy intake from meals and snacks, and the top food groups contributing to meals and snacks. Multivariate linear regression was used to examine the association between meals, snacks, and total eating occasions with daily energy intake for 2- to 5-y-old and 6- to 13-y-old children.
  
  
  RESULTS
  Eating patterns were similar across age groups (per capita mean intake of 3 meals and 1.4-1.6 snacks/d). Each additional snack was associated with greater increases in mean daily energy for older children (+191-289 kcal/d; P < 0.01) relative to younger children (+102-130 kcal/d; P < 0.01). Likewise, each additional eating occasion was associated with greater increases in mean daily energy for older children (+323 kcal/d; P < 0.01) relative to younger children (+166-261 kcal/d; P < 0.01). In both younger and older children, snacking was prevalent (75% and 68%, respectively). Top food contributors to snacks included fruit, salty snacks, candy, sweetened breads, and cookies. Among older children, whole milk as a snack was partially replaced with soda and sweetened fruit drinks.
  
  
  CONCLUSIONS
  Snacks represent an area for potential improvement in the diets of Mexican children, especially among those aged 6 to 13 y, for whom each additional snack or eating occasion was linked to even greater increases in total daily energy intake.
authors.affiliation: Department of Nutrition, University of North Carolina, Chapel Hill, NC; and.
authors.forename: Lindsey Smith
authors.initials: LS
authors.lastname: Taillie
authors.affiliation: Nestlé Research Center, Lausanne, Switzerland.
authors.forename: Myriam C
authors.initials: MC
authors.lastname: Afeiche
authors.affiliation: Nestlé Research Center, Lausanne, Switzerland.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Eldridge
authors.affiliation: Department of Nutrition, University of North Carolina, Chapel Hill, NC; and popkin@unc.edu.
authors.forename: Barry M
authors.identifier: http://orcid.org/0000-0001-9495-9324
authors.initials: BM
authors.lastname: Popkin
mesh_terms: D000293:Adolescent; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008800:Mexico; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009753:Nutritive Value; D062410:Snacks; D012959:Socioeconomic Factors
keywords: Latin America; child diets; dietary behavior; energy intake; preschooler diets; snacks; sugar-sweetened beverages