Associations of Snacks With Diet Quality and Cardiometabolic Risks in Adolescents: National Health and Nutrition Examination Survey

Objectives: To examine the association between snack characteristics (snack frequency, energy density (ED) and nutritional quality) with diet quality and cardiometabolic risks among a nationally representative sample U.S. adolescents.Methods: Cross-sectional dietary data collected using a 24hour dietary recall from the 2011-2016 National Health and Nutrition Examination Survey (1,999 boys and 1,897 girls aged 12-19 years) were analyzed.Snack frequency was measured as the number of snacks per day, self-reported by participants.Snack ED was calculated both with and without beverages.Snack nutritional quality was assessed using the Hybrid Nutrient Density Score.The associations for snack characteristics with diet quality (Healthy Eating Index-2015) and continuous cardiometabolic risk factors (fasting blood glucose, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein, blood pressure, waist circumference, metabolic syndrome risk score) were examined using multiple linear regression, stratified by sex and adjusted for important covariates.Results: Higher snack nutritional quality ( [95% CI]: boys 0.31 [0.09, 0.52]; girls 0.44 [0.30, 0.57]; p < 0.01, p < 0.001), and snack ED excluding beverages ( [95% CI]: boys -1.82 [-2.52, -1.12]; girls -1.75 [-2.69, -0.82]; p < 0.001) were associated with higher diet quality, in both sexes.Among girls, higher snack frequency was associated with lower waist circumference and lower fasting blood glucose.Additionally, higher snack ED and nutritional quality were associated with lower waist circumference and triglycerides, respectively.No associations between snack characteristics and cardiometabolic risks were observed for boys.Conclusions: Findings suggest strategies to improve adolescent snack nutritional quality and ED may improve overall diet quality.However, few modest associations were observed between snack characteristics and cardiometabolic risk indicators among girls.Prospective studies are needed to further investigate the relationship between snack characteristics and adolescent health outcomes.