Associations Between Meal and Snack Frequency and Diet Quality in US Adults: National Health and Nutrition Examination Survey 2003-2012

Background: The associations between eating frequency and diet quality are inconclusive, which might be a result of different effects of meal frequency and snack frequency.

Objective: This cross-sectional study examined the associations of eating frequency, meal frequency, and snack frequency with diet quality, based on data from the National Health and Nutrition Examination Survey 2003-2012.

Design: Dietary intake was assessed in 19,427 US adults aged 20 years or older, using two 24-hour dietary recalls. All eating occasions providing ≥50 kcal were divided into either meals or snacks on the basis of contribution to daily energy intake (≥15% or <15%), self-report, and time (6 am to 10 am, 12 pm to 3 pm, and 6 pm 9 pm or others). Diet quality was assessed using the Healthy Eating Index-2010 (HEI-2010).

Statistical Analyses Performed: Linear regression analyses were performed to explore the associations of eating frequency, meal frequency, and snack frequency (independent variables) with dietary intake variables (dependent variables).

Results: Higher eating frequency was modestly and positively associated with higher HEI-2010 in both men and women; one additional eating occasion per day increased HEI-2010 by 1.77 points in men and 2.22 points in women (both P<0.0001). All measures of meal frequency and snack frequency were also modestly and positively associated with HEI-2010 in both sexes, irrespective of the definition of meals and snacks. However, the associations were stronger for meal frequency than for snack frequency; one additional meal per day increased HEI-2010 by 2.14 to 5.35 points, and one additional snack per day increased HEI-2010 by 1.25 to 1.97 points (all P<0.0001).

Conclusions: In a representative sample of US adults, both meal frequency and snack frequency were modestly associated with better diet quality.