International Journal of Food Sciences and Nutrition

ISSN: 0963-7486 (Print) 1465-3478 (Online) Journal homepage: https://www.tandfonline.com/loi/iijf20

Snacking in nutrition and health

Franca Marangoni, Daniela Martini, Silvia Scaglioni, Michele Sculati, Lorenzo

Maria Donini, Francesco Leonardi, Carlo Agostoni, Gianluca Castelnuovo,
Nicola Ferrara, Andrea Ghiselli, Michelangelo Giampietro, Claudio Maffeis,
Marisa Porrini, Bianca Barbi & Andrea Poli

To cite this article: Franca Marangoni, Daniela Martini, Silvia Scaglioni, Michele Sculati, Lorenzo
Maria Donini, Francesco Leonardi, Carlo Agostoni, Gianluca Castelnuovo, Nicola Ferrara, Andrea
Ghiselli, Michelangelo Giampietro, Claudio Maffeis, Marisa Porrini, Bianca Barbi & Andrea Poli
(2019): Snacking in nutrition and health, International Journal of Food Sciences and Nutrition, DOI:
10.1080/09637486.2019.1595543

To link to this article: https://doi.org/10.1080/09637486.2019.1595543

Published online: 10 Apr 2019.

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INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION
https://doi.org/10.1080/09637486.2019.1595543

RESEARCH ARTICLE

Snacking in nutrition and health

Franca Marangonia , Daniela Martinia,b , Silvia Scaglionic, Michele Sculatid, Lorenzo Maria Doninie,
Francesco Leonardif, Carlo Agostonig,h, Gianluca Castelnuovoi,j, Nicola Ferrarak, Andrea Ghisellil ,
Michelangelo Giampietrom, Claudio Maffeisn, Marisa Porrinio, Bianca Barbia and Andrea Polia
a
Nutrition Foundation of Italy, Milan, Italy; bDepartment of Veterinary Sciences, The Laboratory of Phytochemicals in Physiology,
Human Nutrition Unit, University of Parma, Parma, Italy; cFondazione De Marchi-Department of Pediatrics, IRCCS Ca’ Granda Ospedale
Maggiore Policlinico, Milan, Italy; dSchool of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; eExperimental Medicine
Department, Sapienza University of Rome, Rome, Italy; fItalian Foundation for Food Education, Milan, Italy; gPediatric Intermediate
Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy; hDISCCO (Department of Clinical Sciences and
Community Health), University of Milan, Milan, Italy; iIstituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Verbania,
Italy; jDepartment of Psychology, Catholic University of Milan, Milan, Italy; kItalian Society of Gerontology and Geriatrics and
Department of Translational Medical Science, University of Naples Federico II, Naples, Italy; lConsiglio per la ricerca in agricoltura e
l’analisi dell’economia agraria, CREA-Alimenti e Nutrizione, Rome, Italy; mSchool of Sports, CONI-Italian National Olympic Committee,
Rome, Italy; nDepartment of Surgery, Dentistry, Paediatrics and Gynaecology, Verona University, Verona, Italy; oDepartment of Food,
Environmental and Nutritional Sciences, Division of Human Nutrition, University of Milan, Milan, Italy

ABSTRACT ARTICLE HISTORY

Many studies suggest that distributing energy and nutrient intake across 4–5 eating occasions/ Received 13 February 2019
day (rather than across three standard meals) could favourably affect human health. The Revised 11 March 2019
inclusion of 1–2 snacks in the daily pattern alleviates the potential digestive and metabolic Accepted 12 March 2019
overload caused by fewer heavier meals and might contribute to meet recommendations for
KEYWORDS
food groups (e.g. fruits, dairy) and nutrients like fibre and vitamins. The snack composition Snacking; eating occasion;
should be evaluated taking into account the whole day’s diet. In early and late ages, and for meal frequency; meal
specific population groups, snacking may need to follow particular characteristics in order to timing; dietary intake
be optimal, both in terms of composition and timing. This document, which is the result of a
collaboration of experts across several fields of research, intends to provide a review of the
current scientific literature on meal frequency and health, highlighting the beneficial effects of
correct snack consumption across the human lifespan.

CONTACT Franca Marangoni [email protected] NFI-Nutrition Foundation of Italy, Viale Tunisia 38, 20124 Milan, Italy
ß 2019 Taylor & Francis Group, LLC
2 F. MARANGONI ET AL.

Introduction depend on the timing of its consumption (Leech et al.

2015; Hess et al. 2016).
An active and healthy lifestyle, together with a balanced
This document presents the shared view of a group
diet, is essential to maintain health and well-being
formed of experts from different specialties (paediat-
across all ages. This premise is supported by a wide
rics, geriatrics, nutrition and sports medicine), con-
range of scientific literature, and represents the founda-
vened by NFI – Nutrition Foundation of Italy with
tion of national and international dietary guidelines.
the aim to review the most solid data available in the
In recent decades, many studies have shown that
food and meal consumption habits can also influence literature regarding the effects on health of snack con-
the relationship between diet composition and health. sumption and energy distribution through the day.
Most scientific evidence relates to breakfast’s role in
addition to lunch and dinner: the regular consump- What is the definition of a “snack”?
tion of a breakfast characterised by an adequate
Three main factors, according to the American Heart
energy and nutrient intake is associated with a health-
Association (St-Onge et al. 2017), allow to differenti-
ier overall diet pattern, a favourable metabolic profile,
ate snacks from main meals:
and a better health status (Marangoni et al. 2009).
However, significant changes occurring in daily con-

Consumers’ perception, who traditionally consider
sumption habits have prompted health professionals
breakfast, lunch and dinner as main meals and
and nutritionists to also focus on the effects of caloric
distribution across multiple meals throughout the day. all other eating occasions (e.g. afternoon tea)
Some interesting (and in part counterintuitive) data as snacks.
have already been collected. Although an excess of
The timing of consumption: breakfast, lunch and
calories and specific nutrients is known to produce dinner are commonly considered to take place
negative consequences for health, for example, recent between 6 am and 10 am, 12 pm and 3 pm and
studies have focussed on the association between 7 pm and 9 pm, respectively. All other eating occa-
energy distribution throughout the day and diet qual- sions are considered snack times.
ity and specific health parameters (Koletzko and
Energy intake: meals and snacks are categorised
Toschke 2010; Schoenfeld et al. 2015; Murakami and according to the energy content: over 15% and less
Livingstone 2016). than 15% of the daily recommended energy intake,
A number of scientific bodies and scientific soci- respectively.
eties currently argue that distributing energy and
nutrients across 4–5 daily meals could potentially Another distinction must be made in terms of
benefit health (Institute of Medicine 2007; Agostoni nutritional composition between mid-morning and
et al. 2011). Specifically, in a healthy population, it mid-afternoon snacks, as the two may play different
has been found that consuming 1–2 nutritionally and roles in the diet. The mid-morning snack is intended
calorically balanced snacks between meals may con- to maintain a sense of satiety, allowing an individual
tribute to meet the recommended consumption levels to reach lunch time with a sufficient but not uncon-
of healthy foods such as milk and fruit, as well as for trollable appetite, and should therefore be easily
vitamins (e.g. folate), minerals (e.g. calcium, zinc and digestible and not excessively rich in calories. The
iron) and fibre (Sebastian et al. 2008; Lloyd-Williams timing and the energy content of the afternoon
et al. 2009; Zizza et al. 2010). This eating pattern may snacks, on the other hand, must be tailored based on
also alleviate the potential digestive and metabolic both the longer duration of the afternoon compared
overload caused by a lower number of meals with to the morning, and the engagement in physical activ-
higher energy content, particularly at dinner (Maffeis ity in the afternoon if appropriate.
et al. 2000). In addition, snacks provide the opportunity to sup-
A small meal consumed at either mid-morning plement the diet with foods the consumption of which
and/or mid-afternoon has also been associated with at main meals is for any reason inadequate. For
other positive metabolic effects (Gatenby 1997; example, eating fruit as a mid-morning snack is a per-
St-Onge et al. 2017). Recent findings suggest that pre- fect way to achieve the recommended daily intake of
venting a rapid increase in hunger is an essential tool fruit in addition to that consumed at lunch or dinner.
for weight maintenance in all age groups (Zeevi et al. Furthermore, snack represents an excellent opportun-
2015). It is important to consider that such effects, as ity to introduce into the diet this precious group of
well as the nutritional value of a snack as a meal, also foods, which is usually scarcely consumed.
 INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 3

With regards to the nutritional characteristics of and Popkin 2010). Similarly, in Australia snacks con-
snacks, it is both unrealistic and impractical to man- tribute to 30% of total calories during childhood and
datorily follow the same macronutrient distribution adolescence (Fayet-Moore et al. 2017). In China, the
that is generally suggested for the overall diet (e.g. current situation has significantly changed compared
45–60% carbohydrates, 20–35% fat and the remaining to previous decades and is progressing towards a more
part from protein, as indicated by EFSA). Such distri- western-type model (Wang et al. 2018). In 1991, only
bution can easily be reached through total daily 14% of children aged 7–12 years consumed snacks,
intake, regardless of the snack’s nutritional compos- whilst in 2009, 54% of Chinese children habitually
ition, assuming that the composition of main meals is consumed snacks, on average once per day, although
appropriate. Consequently, no food should be a priori the snacks were relatively low in energy density (6–8%
excluded from the snack, provided that all daily eating of daily energy intake). In 2012, 68% of Mexican chil-
occasions and energy requirements are adequately dren consumed snacks on average 1.2 times per day
taken into account. Moreover, following such a strict and recent data suggest that approximately 19% of the
caloric distribution for snacks would imply, for energy intake for Mexican children is derived from
example, that a piece of fruit is nutritionally inad- snacks (Taillie et al. 2015).
equate, whilst this is clearly not the case.
Recommendations for snack consumption
Snacking habits and consumption around
As recently pointed out by Potter et al., amongst more
the world
than 200 countries and organisation, 136 snacking-
Snack consumption habits vary greatly from one specific recommendations were identified, significantly
country to another. It has been shown that Australia different from one another (Potter et al. 2018).
and the United States are the top snack consumers, Despite this, with the exception of certain countries
followed by Mexico and China (Wang et al. 2018). such as China (National Institute of Nutrition and
Between 1977 and 2014, in the United States, an Health 2008) and Mexico (Bonvecchio-Arenas et al.
increasing trend in snack consumption took place 2015), most nutritional recommendations focus on the
across all socioeconomic classes which resulted in a diet as a whole and do not specifically address snack-
significant increase in calories per capita derived from ing (National Health and Medical Research Council
between-meal snacks (Dunford and Popkin 2018). 2013; U.S. Department of Agriculture ARS 2015). This
If the different types of food consumed as snacks approach can be justified considering, as previously
are considered, fruit and milk/yogurt consumption mentioned, that a single snack has a modest impact
appears to be very low amongst adolescents (9–13 on the diet in terms of energy (less than 10% of total
years) compared to children aged 4–8 years. daily intake). Therefore, the impact of the varying
In the United States, as well as in Australia and nature of snacks on overall diet quality is likely to be
Mexico, snacks have the highest nutritional density, relatively limited.
added sugars and saturated fat content. An increasing Current leading nutritional advice suggests that
trend in savoury snack consumption, especially in children should consume snacks between main meals
China, Mexico and the United States, can be identi- in order to meet their nutritional requirements. For
fied. With the exception of Blacks and Hispanics, example, the Italian guidelines in this regard state that
the consumption of sugary beverages has decreased three main meals are not sufficient to meet the needs
amongst the general population, whereas the prefer- of children and teenagers and it is therefore advisable
ence for savoury snacks is increasing. to provide them with two calibrated snacks to meet
The caloric intake from snacks has especially the particular needs of calories and nutrients of
increased (by over 100%) for children with lower edu- this age (INRAN – Istituto Nazionale di Ricerca per gli
cational and socioeconomic backgrounds. Alimenti e la Nutrizione 2003); the American
Significant differences between industrialised coun- Paediatrics Academy (American Academy of Pediatrics
tries versus developing countries can be also found Committee on Nutrition 2004) and the United States
regarding the prevalence, frequency, energy content Department of Agriculture (USDA Food and Nutrition
and nutrient intake of snacks. In the United States, in Service 2016) suggest 2–3 small snacks per day for
the 90s, 80% of children aged between 2 and 18 years pre-school aged children. More specifically, the USDA
consumed snacks, versus 95% in 2013–2014, contribu- suggests that “smart snacks” should be prioritised,
ting to 24% of the average daily energy intake (Piernas consisting of fruit, vegetables and water. In order to be
4 F. MARANGONI ET AL.

considered a “smart snack”, a snack must first meet was later confirmed by Australian researchers who
the general nutrition standards: be a grain product observed a peak in hunger between 5 pm and 9 pm,
with at least 50% whole grains by weight (have a whole whilst the lowest level was recorded during the night
grain as the first ingredient); or have as the first ingre- (1 am–5 am) (Sargent et al. 2016). The findings from
dient a fruit, a vegetable, a dairy product or a protein these studies are aligned with the mechanisms of
food; or be a combination food that contains at least appetite regulation, in particular the hormonal secre-
1=4 cup of fruit and/or vegetable; moreover, a “smart tions that regulate appetite, appetite-stimulating ghre-
snack” must meet the nutrient standards for calories, lin on one hand and appetite-suppressing leptin on
sodium, sugar and fats. the other (Simon et al. 1998; Cummings et al. 2001).
Similarly in Canada, Alberta’s Health Services con- Another study recently measured the response of
siders that children require 2–3 snacks per day, and obese subjects to a standard meal consumed either in
that portions should vary based on age, physical activ- the morning or in the afternoon. It was observed that
ity level and the time period between the snack and ghrelin secretion and hunger were highest in the after-
the subsequent meal (Alberta Health Services 2016). noon, whereas peptide YY was lower. The results were
In France, the recommendations provided by the even more marked when subjects underwent a stress
Programme National Nutrition Sant
e (National Health test (Carnell et al. 2018).
and Nutrition Program) suggest that a single after- The increase in afternoon appetite mainly concerns
noon snack is sufficient for children; it should include high energy dense and highly palatable foods and
food belonging to two of the three following food does not involve vegetables for example (Scheer et al.
groups: bread or cereal, dairy and fruit (Programme 2013). It appears that at night, humans primarily seek
National Nutrition Sant
e 2013). energy and gratification.
Based on these observations, the role of mid-after-
noon snacks appears particularly important. In fact,
Why is snacking important? The physiology and
consuming a nutritionally adequate snack may prevent
circadian rhythms behind hunger and appetite
an overconsumption of food during the following
The field of energy regulation has recently focussed hours that are considered critical in terms of regulat-
on analysing not only what type of food is consumed ing food behaviours.
but also how and when consumption takes place When referring to “nutritionally adequate” food
(Arble et al. 2009; Garaulet et al. 2013). properties, the main factors include nutrient density
If food intake were to be exclusively regulated by and energy density which play major roles in main-
energy homeostasis processes, our appetite would be taining energy balance (Drewnowski 2018). It was
greatest upon rising, following a night of fasting. found that, for adolescent males, consuming a nutri-
However, breakfast is often the least caloric of all daily ent dense snack in the afternoon improves appetite
meals, and poor morning appetite (and consequently control, satiety and overall diet quality (Leidy et al.
breakfast skipping) is especially prevalent amongst 2015). A literature review also highlighted an
overweight and obese individuals (Deshmukh-Taskar improvement in satiety after consuming nutrient rich
et al. 2010). In the Western food tradition, dinner is snacks (Njike et al. 2016). Such effects cannot be
generally the most important meal, contributing to attributed to a specific nutrient, as evidenced by the
over a third of total daily energy intake (De Castro comparison between protein-rich Greek yogurt and
1997; Agricultural Research Service 2012). This is a regular yogurt (Ortinau et al. 2013), and are instead
potential issue given that energy intake at night is related to the snack’s overall nutrient density. On the
positively correlated with total energy consumption other hand, snacks that have high energy density and
throughout the day (de Castro 2004). low nutritional density can lead to a positive energy
There are several reasons that explain such changes balance, resulting in overweight, especially when con-
in energy intake distribution including genetic predis- sumed regularly, mindlessly and in the absence of
position (de Castro 2001) and social and family hunger signals (Larson et al. 2016).
behaviours (Patrick and Nicklas 2005). Afternoon snacks may therefore represent a means
Over the past few years, circadian rhythms of hun- of controlling appetite and eating behaviour, assuming
ger and satiety have also been considered (Scheer that healthy options are chosen and consumed mind-
et al. 2013; Poggiogalle et al. 2018). Scheer was the fully. The positive effects of an afternoon snack are
first to demonstrate that hunger sensations peak particularly useful given the circadian cycle of hunger
around 8 pm and reach a nadir at 8 am. This finding sensations. Consuming snacks that can limit the
 INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 5

physiological hunger peak that takes place at night, period (Piernas and Popkin 2010). American children
can in fact assist with controlling food intake. consume an average of three snacks per day, and over
Time and frequency of meal consumption can also a third of their total energy intake is provided by des-
influence daily glycaemic variability and insulin secre- serts and sugary drinks. A significantly higher energy
tion (Leidy and Campbell 2011). density for snacks compared to the three main meals
Skipping meals, as opposed to more frequent meal has also been recorded (Cole and Fox 2008).
consumption (within an overall isocaloric context), In light of these data, there is currently no consen-
leads to higher postprandial insulin peaks due to the sus regarding the relationship between the number of
proportionally higher carbohydrate intakes during the daily meals and child body weight (American Dietetic
remaining meals. In healthy young males, for example, Association 2008; Evans et al. 2015).
isocaloric diets (15 En% protein, 30 En% fat and 55 In general, the literature suggests that there is an
En% carbohydrates) were divided into either three inverse relationship between meal frequency and
daily meals (a low consumption frequency pattern) or weight status (Kaisari et al. 2013; Larson and Story
14 meals (ensuring that subjects were in a constant 2013). Although the nature of this relationship is yet
postprandial state) (Bosy-Westphal et al. 2017). These to be elucidated, it confirms the role of an increased
diets induced different changes in blood glucose and eating frequency in maintaining low levels of hunger
insulin which were significantly greater in response to and appetite.
a lower number of meals, even in the presence of no The most reliable data on this topic come from
variations of the overall macronutrient distribution studies evaluating the association between meal fre-
over 24 h. The metabolic consequences of these phe- quency and total energy intake, taking into account
nomena are important. the overall diet quality, measured using the Healthy
If the energy balance is positive, a reduced meal fre- Eating Index 2005 (HEI-2005).
quency (due to the greater induced insulin response) A study of eating behaviours on 176 children (aged
will lead to an increased absorption and oxidation of 9–11 years) and adolescents (12–15 years) showed that
cellular glucose in the immediate postprandial phase, for the 82% of the participants who consumed an aver-
as well as to the accumulation of fat ingested through age of three daily meals, meal and snack consumption
the diet in adipose tissue (for the insulin-induced frequencies were significantly and positively associated
activation of lipoprotein lipase). On the contrary, with total energy intake (Evans et al. 2015). In fact,
when insulin levels are kept lower (such as when each additional meal and snack was associated with an
carbohydrate intake is spread across several meals), increase in energy of 18.5% and 9.4%, respectively
lipolysis is activated and the resulting substrate flow (p < .001). However, the relationship between number
follows the opposite pathway. of meals or snacks and diet quality varied across age
However, it must not be forgotten that insulin groups: for primary school children, the number of eat-
secretion is just one of the many drivers affecting the ing and snacking occasions was generally associated
complex mechanism of regulation of the energetic with a greater score on the diet quality index. On the
homeostasis and a division in more than six daily other hand, for adolescents, each additional main meal
meals should not be necessarily be considered advan- was associated with an increase of 5.4 points (p ¼ .01)
tageous (McCrory and Campbell 2011). in the diet quality index, whilst a reduction of 2.73
points was observed for each additional snack.
In Canada, snacks contribute to over a third of
Snack consumption: relationship with overall diet
total energy intake for 96% of children, who consume
and health status
an average of 2.3 ± 0.7 snacks per day. For most of
Given that most of the available data on this topic these children (78% of boys and 63% of girls), the
originates from the United States of America, it must snack was comprised of a food belonging to a healthy
be interpreted prudently whilst considering the clear food category (Hutchinson et al. 2018).
differences in eating behaviour and lifestyle compared
to Mediterranean countries.
Snacking and overweight/obesity in children
In the United States for people aged between 2
and 18 years, average daily meal frequency has The snacking stereotype consists of consuming
increased from 3 to 5 times between 1970 and 2000 unhealthy and oftentimes excessive amounts of food,
(Popkin and Duffey 2010), with an average daily cal- in terms of both calories and nutritional content,
oric increase of 770 kJ (184 kcal) during the same time mainly rich in fat and/or sugar. Snacking, as a
6 F. MARANGONI ET AL.

consequence, has often been considered as a potential the general theory of weight control (Zeevi
driver for overweight and abdominal obesity amongst et al. 2015).
children and adolescents (van Jaarsveld et al. 2014; A high level of emotion-driven impulsiveness has
Murakami and Livingstone 2016), especially amongst been also shown to be positively associated with the
those who consume more than 15–20% of their daily frequency of snacking and particularly with the con-
energy intake in the form of snacks (Hampl et al. sumption of energy-dense snacks, thus confirming the
2003). In this population group, as previously men- importance of targeting on impulsiveness to avoid
tioned, snacking frequency was positively associated excessive and/or poor quality snacking (Coumans
with total energy intake. However, meal and snack et al. 2018). Stress has also been increasingly gaining
frequency was correlated with an improvement in attention with regards to its role in conditioning food
overall nutritional quality in school aged children, choices as early as at 8–9 years of age (Carnell et al.
whilst for adolescents it was associated with a less 2018; Hill et al. 2018). According to these data,
favourable diet from a nutritional point of view addressing emotional impulsiveness may be an effect-
(Evans et al. 2015). ive strategy to avoid excessive food consumption
An Italian study conducted on 1837 children aged between meals.
between 8 and 10 years showed that overweight and In addition to potentially influencing weight, meal
obese children clearly preferred savoury snacks com- frequency also affects oral health if proper hygiene
pared to sweet varieties and their consumption was practices are not followed. This is particularly relevant
directly associated with the degree of excess body- especially for sweet foods and drinks, the consump-
weight (Maffeis et al. 2008). tion levels of which directly correlate with the devel-
It is likely that overweight children are less sensi- opment of dental caries (Paglia et al. 2016; O’Malley
tive to satiety cues and perhaps more sensitive to cues
et al. 2018). Both the amount and the nutritional con-
that promote food consumption (Cross et al. 2014). It
tent of snacks appear to contribute to the risk of car-
was demonstrated that these differences in responses
ies (Olczak-Kowalczyk et al. 2017). In particular, this
can influence weight gain during the early stages of
risk is greater for school-aged children who consume
life (Mallan et al. 2014; van Jaarsveld et al. 2014). A
numerous snacks instead of regular main meals (OR
recent study conducted with 187 Hispanic pre-school
¼ 2.32) (Skafida and Chambers 2018). Similarly, con-
aged children established a positive correlation
suming sweet foods in the evening may facilitate pla-
between the pleasure derived from food and the fre-
que formation and thus dental caries in pre-school-
quency of snacks and calories consumed between
aged children (Wigen et al. 2018). Following the
meals in overweight and obese children. An inverse
nutritional advice of dentists and dietitians (for
relationship was observed for normal weight children
(Rudy et al. 2018). These observations call for a differ- example choosing fruit and unsweetened/moderately
ent approach with regards to snacking recommenda- sweetened yogurt and thoroughly cleaning teeth after
tions for overweight and obese children who have the last daily meal) significantly reduces the risk of
difficulty regulating their appetite (Bo et al. 2014). dental caries (Heima et al. 2016).
Research on different food categories with varying
characteristics has shown that protein and fibre rich The benefits of mid-morning and mid-
foods play a major role in satiety if they are consumed afternoon snacks
as snacks (e.g. nuts, yogurt, dried prunes). However,
certain authors have suggested that overall diet quality There is no clear consensus in the literature regarding
is mainly influenced by the nutritional quality of main the appropriate number of meals per day. For this
meals, given their large contribution to total energy reason, the American Society for Nutrition organised
intake. Nonetheless, even if the contribution of snacks a symposium on this topic whose contents were pub-
to total energy is relatively small, it is reasonable to lished in 2011 to define a few practical suggestions for
assume that they can still potentially lower overall diet the general public.
quality (Murakami 2018). The literature suggests that consuming 3–6 meals
Consuming healthy snacks appears to influence per day is associated with improved appetite control,
satiety by promoting appetite control, thus reducing provided that energy intake at each eating occasion is
the risk of overweight and obesity, as demonstrated in monitored in order not to exceed energy requirement
healthy children (Njike et al. 2016). This finding is (McCrory and Campbell 2011). Eating mindlessly
consistent with the Weizmann Institute’s research on increases the risk of destabilising appetite cues, thus
 INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 7

increasing caloric intake especially when consuming their tendency to resort to “comfort food” in times of
more than six meals per day. boredom, stress, worry or anger. In women free from
However, as previously mentioned, balanced depressive disorders, it was found that measured stress
snacking is essential for regulating satiety hormones perception, following critical moments, was lower in
between meals, which prevents ravenousness prior to those who turned to comfort food.
the following meal. In contrast, reducing the number Overall, it appears that snacks can reduce stress
of meals per day is associated with a reduced cap- under certain circumstances, as well as represent
acity for appetite control (Leidy and Campbell 2011). enjoyable treats within very strict diets. Such diets are
Most researchers agree that regular and structured often unsuccessful in the long-term and can poten-
eating patterns can facilitate weight control, whereas tially lead to contrasting behaviours (for example,
“grazing” led by impulsiveness, as opposed to mind- compensatory eating or binges), whilst flexible eating
ful decisions, negatively impacts overall diet quality patterns are easier to maintain, and can be consoli-
and body weight (Berg and Forslund 2015; Leech dated through pleasurable eating habits such as snack-
et al. 2017). Moreover, regular small meals positively ing (Stewart et al. 2002).
affect metabolism compared to fewer larger meals
throughout the day (Jenkins et al. 1989).
Snacks: psychological aspects, social and
Multiple studies have focussed on the association
educational role
between food consumption frequency and several
chronic disease markers, such as body weight, blood The main factors influencing snack food choices
pressure, lipid and glycaemic profiles, etc. (St-Onge include food culture, education and socioeconomic
et al. 2017). Although further studies are required, a status (Wang et al. 2016).
higher food consumption frequency is associated A moderate level of control and encouragement has
with a lower risk of obesity in children and adoles- been associated with a lower consumption of inad-
cents. In contrast, regularly skipping meals is usually equate snacks. On the other hand, using food as a
associated with greater metabolic risk, such as a reward or in response to a negative mood has been
higher BMI, waist circumference, fasting levels of associated with a higher level of unhealthy snack con-
blood insulin and glucose and triglycerides sumption amongst children (Sleddens et al. 2010;
(Deshmukh-Taskar et al. 2010; Freitas J
unior et al. Rodenburg et al. 2014; Lo et al. 2015), as confirmed by
2012; Schr€oder et al. 2017). a study evaluating the effect of limiting snacks in the
It must also be noted that snacks provide an absence of hunger for 64 groups of parents and their
opportunity to consume certain foods or macronu- 22–36 months old children (Corsini et al. 2018). The
trients that may not be sufficiently consumed during study accounted for three specific factors: access to
mealtimes (Fayet-Moore et al. 2017). A typical snacks, snack consumption frequency and proclivity for
example is fruit, which constitutes a healthy snack snacks. Snack consumption in a non-hungry state was
either mid-morning or mid-afternoon, especially if associated with restrictive behaviours on the parents’
daily intake is not covered during breakfast, lunch behalf (r ¼ 0.25, p¼.05, IC 95% 0.004–0.47). In particu-
and dinner. Fruit snacks can hence contribute to lar, access to snacks at home was on average greater
improving overall diet quality, whilst also helping con- and directly correlated with restriction (van Ansem
sumers to reach their daily recommended target of et al. 2015; Blaine et al. 2017; Corsini et al. 2018).
2–3 daily portions as suggested by dietary guidelines. A behavioural study was conducted with school-aged
Finally, it must be highlighted that consuming overweight and obese children who were provided
snacks as “comfort food” is not necessarily a sign of with sweet and savoury snacks following a pizza dinner
weakness, but may instead be beneficial, in specific (Liang et al. 2016). Parents’ responses to an adequate
cases, as part of a varied and balanced diet (Troisi questionnaire showed that excessive monitoring and
and Gabriel 2011). This premise is supported by a control led to negative effects on children’s eating
study from the Department of Psychology at the behaviours. For those children whose parents were the
University of California (Finch and Tomiyama 2015). most psychologically controlling, the tendency to con-
The researchers analysed data from 2379 women sume snacks in the absence of hunger was greater.
(aged 18–19 years) who were enrolled in a large Another survey, conducted in 2010 on 1215 chil-
observational study which also included psychological dren 6–10 years old, representative of the Italian
tests. The tests aimed to assess how participants would population for this age group, found that snacking is
react during critical moments and, on the other hand, not a merely individual choice and is largely
8 F. MARANGONI ET AL.

influenced by peers (Gregori et al. 2011). In this at home, suggesting that an educational intervention
study, the likelihood of eating three or more sweet performed during class time may provide benefits
foods/drinks per day (typical snackers’ behaviour) which extend beyond the time spent in the classroom.
equivalent to an average caloric intake of 360–400 kcal In addition, given that snacks can contribute to up
(18–22% of the daily recommended intake of to 20% of daily calories, food and beverages should be
1700–1900 kcal/day for children aged 6–10), was selected to add nutritional value to the diet without
higher in situations in which child’s peers are also exceeding the maximum energy limit (Zizza 2014).
snackers. It was also shown that the increase in energy Moreover, the importance of adequate hydration
intake due to snacking behaviours may be compen- should not be underestimated, especially at this stage
sated through an active lifestyle. In fact, in Italy, chil- of life: it is recommended to provide children with
dren considered “snackers” lead more active lifestyles water along with their snacks.
compared to non-snackers (van der Horst et al. 2008; Finally, it is important to ensure a variety of snacks
Gregori et al. 2011). This finding contradicts another throughout the week, within a varied diet, in order to
study which generally describes snackers as children prevent boredom created by routine and repetitiveness
who spend most of their time involved in solitary and to increase the likelihood of maintaining healthy
activities (Gubbels et al. 2009). In the Italian popula- habits in the long-term.
tion, no correlation was observed between the parents’
BMI and their children’s level of snack consumption. Adults
According to the results, the children’s eating habits
If considered as a tool to meet daily requirements,
are closely linked to their mother’s attitude towards
snacking among adults may be less important than in
physical activity. Mothers of non-snackers are more
children and adolescents. However, it can play an
inclined towards healthy behaviours including a min-
important role for the adult population for different
imum of two weekly hours of physical exercise. This
reasons. Rather than consuming three large meals
issue does not necessarily imply a healthier lifestyle
(breakfast, lunch and dinner), adults can consume
for their children who appear to have not only a more
smaller portions of food spread across 4–6 eating
sedentary lifestyle but also less social contact. On the
occasions every 2–3 h (St-Onge et al. 2017).
contrary, children who regularly snack spend more
Distributing daily energy intake across five eating
time watching TV but are also more active, most of
occasions, as opposed to concentrating it within three
them practicing physical activity at least 4 h per week.
main daily meals, can positively impact several meta-
In conclusion, the association between snacking
bolic and health parameters (F
abry et al. 1964).
behaviours in children and overweight-obesity
Guidelines from several countries including Italy
remains unclear.
(Italian Ministry of Health) suggest that breakfast
should contribute to 15–20% of total energy, 60–70%
Snacking at different ages in life: practical issues for lunch and dinner, whilst the remaining amount
should be divided between mid-morning and mid-
Children and adolescents
afternoon snacks.
Snacks for children and adolescents should be wisely This energy distribution is associated with an
chosen, in order to provide a valuable contribution to adequate energy distribution, meeting the body’s
the overall diet. Both sensory aspects of the foods that requirements throughout the day, and resulting in a
constitute the snack and a thorough evaluation of the reduced appetite before the main meals. In addition,
food and beverages consumed during the rest of the it promotes a more balanced secretion of gastrointes-
day should be taken into account. tinal hormones (including insulin and ghrelin) and an
For children and adolescents, for example, snacks improved control of glycaemia, appetite, cholesterol
are an opportunity to meet nutritional recommenda- and body weight (F
abry et al. 1964; Bellisle et al.
tions for the consumption of milk and dairy products, 1997; Palmer et al. 2009).
fruit and fibre. It should not be forgotten that, given the wide avail-
Education plays a major role in this context, as ability of food in our society, an increase in eating occa-
demonstrated by the US government’s plan to provide sions may easily lead to an increased caloric intake
fruit and vegetables as snacks in primary schools (Bert
eus Forslund et al. 2005). Whilst increasing meals
(Ohri-Vachaspati et al. 2012). This initiative proved from 3 to 5–6 per day may have positive effects, exceed-
successful in increasing the consumption of vegetables ing this frequency may lead to weight gain. It is there-
throughout the day and encouraging healthy choices fore important for adults and elderly people to consider
 INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 9

mid-afternoon snacks as a means to obtain a proper factors (such as depression, often associated in the eld-
energy distribution throughout the day and to increase erly with the loss of social position) can also play
the eating occasions for particular foods. Studies a role.
on obese adults undergoing weight loss treatment dem- In this context, meal distribution across 5–6 eating
onstrated that those who regularly consume snacks occasions can help food consumption, particularly
tend to consume more fibre, fruit and vegetables com- amongst individuals who cannot tolerate large quanti-
pared to those who do not (Kong et al. 2011). ties of food in one sitting. Even in the absence of spe-
A greater consumption of snacks, if properly for- cific clinical trials, several guidelines regarding
mulated, does not necessarily lead to an increase in nutrition in the elderly suggest that eating smaller, but
body weight. This suggests that there may be compen- more regular, meals can improve nutritional status in
satory factors which regulate energy intake during these persons (e.g. Best Practice Advocacy Centre
other meals, especially in normal weight individuals New Zealand, Henry Ford Allegiance Health, Irish
(Viskaal-van Dongen et al. 2010; Njike et al. 2016). Nutrition and Dietetic Institute, Senior Care Corner)
The composition and consistency of snacks, rather (Wilkinson and McLeod 2008).
than the frequency of snacking occasions, appears to To reach this goal, snacks (like other meals) should
impact on satiety and feeling of fullness (Furchner- contain foods providing essential nutrients and should
Evanson et al. 2010). meet specific criteria, which may be different from
Since consumers are less likely to consider liquid those for other age groups. For example, highly
or semi-liquid foods as sources of calories compared digestible yet appealing and energy dense foods should
to solid foods, compensatory behaviours during subse- be prioritised. High energy density allows for a reduc-
tion of up to 20% in food volume whilst maintaining
quent meals are less likely to take place after these
energy intake. Appealing flavours and presentation
foods, potentially leading to an increase in total daily
can also enhance trigeminal stimuli (texture changes,
energy intake (Mourao et al. 2007).
temperature control) as well as visual stimuli (colour
changes), thus improving appetite and overall food
The elderly
intake (Donini et al. 2016).
A well-timed and nutritionally appropriate snack can
exert a positive effect on the diet of elderly people. Athletes and highly active individuals
Malnutrition, nowadays, still affects about 38–50% of
Physical performance of recreational and professional
elderly patients admitted to hospital, 14% of patients
athletes requires proper nutrition habits to be attained
admitted to nursing homes and 6% of free-living indi-
and maintained (Rodriguez et al. 2009). The main pri-
viduals (Kaiser et al. 2010). These data suggest that
orities for athletes are adequate intakes of energy, flu-
nutritional deficiencies affect a large part of the elderly ids and carbohydrates. In addition, combining
population. carbohydrates with an adequate protein intake and
Food choices in the elderly are largely influenced preventing excessively long fasting periods, can pro-
by well recognised factors, including biological deter- mote and maximise muscle protein synthesis.
minants (hunger and satiety signals: endogenous pro- Physical performance can be supported by
duction of neuromodulators, macronutrients, energy adequate intakes of liquids, carbohydrates and pro-
density), food palatability (taste, smell, texture, sight tein before, during and after physical activity requir-
and hearing), economic and environmental factors ing muscle strength.
(accessibility, degree of autonomy), social aspects (cul- Compared to the general population, athletes
tural background, family and social support) and psy- require higher intakes of fluids (to compensate for
chological determinants (stress, depression) (Donini sweat losses) as well as additional energy for physical
et al. 2016). performance. Most athletes, therefore, may benefit
A sub-optimal diet that does not meet energy and from an increased meal frequency. The scientific lit-
nutrient requirements can be also the consequence, erature concerning nutrition and physical activity
amongst elderly people, of age-related physiological highlights that meal frequency plays an important role
changes such as reduced chewing ability, reduced saliv- both before and during training, and when preparing
ary gland activity, altered gastroesophageal motility for a competitive event (Kerksick et al. 2017).
and secretions, reduction of the intestinal absorption In particular, the number of eating occasions and
surface area, concomitant diseases. Social issues (pov- the macronutrient distribution in various meals are
erty, loneliness, social isolation) and psychological essential to resynthesise muscular and hepatic
10 F. MARANGONI ET AL.

glycogen, for muscle mass repair, protein synthesis consumed sufficient amounts of carbohydrates before
and to improve mood following physical exertion. the competition or if training is taking place in
In fact, intense and prolonged exercise promotes extreme environmental conditions (e.g. extreme heat
the metabolic use of glycogen stores, that must subse- or cold, high altitudes) (Rodriguez et al. 2009).
quently be replenished (within 4 h from exertion). The ACSM underlines that post-training recovery
This goal can be achieved by consuming carbohy- goals, in athletes, include restoring fluids and electro-
drates, also in combination with proteins, especially lytes lost through sweat, restoring the glycogen con-
when intense physical activity is extended over a lon- sumed during exercise, optimising protein synthesis
ger time period. required to repair damaged muscles and to build new
Individuals who train regularly and at high inten- tissue. As a consequence, following training, the nutri-
sity (i.e. once per day for 2–3 h, 5–7 days a week, tional purpose of a snack is essentially to replenish lost
for 9–10 months a year) also require higher protein fluids, energy, carbohydrates, protein, minerals and
intakes, generally set between 1.2 and 2.0 g/kg of vitamins. Thus it must supply an adequate amount of
body weight. energy, mainly from carbohydrate sources (in order to
According to the American College of Sports replenish muscle and liver glycogen stores). The post-
Medicine (ACSM), muscle adaptation to training can exercise snack is also essential for restoring protein and
be optimised by consuming 0.3 g/kg of body weight of to provide the aminoacids required for repairing exer-
protein, over several meals, following training sessions cise-induced muscle damage. It is generally recom-
and every 3–5 h (Thomas et al. 2016). Interestingly, mended that athletes consume carbohydrate and
readily available carbohydrates promote protein spar- protein rich snacks before and after training supplying
ing during physical activity (Kerksick et al. 2017). at least two and up to 4–5 g of carbohydrates for each
Protein intake is especially relevant in the case of gram of protein. This ratio supports anabolic processes
inadequate energy and carbohydrate intake, when pro- (muscle repair caused by physical exercise and muscle
tein enables good glycaemic balance and an increase mass increase) that are most active immediately post-
in glycogen stores. Similar benefits are observed with training (i.e. within 30 min of completion), commonly
carbohydrates during resistance training; in the long- referred to as the “anabolic window”.
term they promote muscle adaptation if physical exer- Generally speaking, the distribution of calories
cise is maintained. across meals, amongst athletes, mainly depends on the
Preliminary studies have shown the potential bene- type of physical activity, on the time of training as
fits associated with meal frequency on weight main- well as on individual traits (La Bounty et al. 2011). If
tenance and body composition for physically active training takes place mainly in the afternoon, breakfast
individuals (La Bounty et al. 2011). and lunch should contribute to 20% and 30% of total
Snacks are therefore essential for athletes perform- daily calories, respectively. The addition of a mid-
ing at elite levels, given that they provide the required morning snack providing 5–10% total energy should
energy pre-training and the essential nutrients for involve the reduction of the energy intake at lunch,
post-training recovery. Considering that competitions that should not exceed 25–30%, followed by a mid-
or training sessions must take place at least 3 h follow- afternoon snack providing 10% and a small snack
ing a main meal (i.e. starter, main dish, sides and during training providing 5%. In all cases, carbohy-
fruit/dessert), snacks prevent athletes from performing drates should be the main source of energy. Although
with a completely empty stomach, which would nega- requirements of protein and certain vitamins (espe-
tively affect performance (Thomas et al. 2016). cially B group vitamins) increase with exercise, the
A snack consumed before a competition or training increase in energy, fluid and carbohydrate require-
session should be characterised by a relatively low fat ments is proportionately much greater. Ideally, the
and fibre content, in order to promote gastric empty- distribution of meals should provide adequate and
ing and minimise gastrointestinal distress, and should constant sustenance throughout the day thus prevent-
be high in carbohydrates. It should also provide suffi- ing drops in blood sugar which may compromise per-
cient fluids to maintain adequate hydration through- formance (Thomas et al. 2016).
out physical exertion. The presence of carbohydrates
in such snacks is essential since they maintain blood
Conclusions
glucose levels during physical activity (30–60 g per
hour on average). This is especially true for physical Many scientific bodies highlight the benefits of dis-
exertion that exceeds 60 min, if the athlete has not tributing total energy and nutrients across 4–5 daily
 INTERNATIONAL JOURNAL OF FOOD SCIENCES AND NUTRITION 11

Figure 1. Mid-morning and mid-afternoon snacks: main characteristics and nutritional and health effects.

meals as opposed to 2–3 main meals. This approach is complete the daily cognitive and physical tasks that
based on available evidence suggesting that in healthy, take place between main meals.
normal weight adults, a favourable association A strategically and well designed snack can also
between the number of meals consumed throughout compensate for “quantitative” metabolic imbalances at
the day and the nutritional diet quality and the indi- all ages and in all contexts.
vidual cardio-metabolic profile can be demonstrated. Moreover, snacks can provide specific benefits for
This optimal pattern consists of three main meals various population groups, especially for those who
(breakfast, lunch and dinner), one mid-morning and can greatly benefit from more frequent meal con-
one mid-afternoon snack. sumption such as children and the elderly. Correct
Both mid-morning and mid-afternoon snacks must timing and planning of snacks (including water for
be well characterised in terms of time of consumption, adequate hydration) can also significantly impact the
energy content (generally 10% of total energy intake, quality of a snack. Snacks for both amateur and pro-
but with some flexibility according to individual fac- fessional athletes require special attention given that
tors) and mode of consumption. Adequacy to individ- timing, nutritional composition and mode of con-
ual requirement, lifestyle and habits, time planning sumption are crucial determining factors for athletic
and variety allow for mid-morning and mid-afternoon performance.
snacks to be distinguished from other snacking times
(Figure 1).
From a nutritional perspective, allowing for three Disclosure statement
plus one or two eating occasions can also help to opti- All the authors have undersigned a conflict of interest dec-
mise the intake of certain foods such as fruit and laration on the topic of this manuscript. AP and FM are
dairy products and to reach nutrient requirements respectively President and responsible for research at NFI, a
especially for vitamins and minerals. non-profit organisation partially supported by 19 food com-
A mid-afternoon snack is also associated with psy- panies, some of which may have financial interests in the
topic. CA declares speaking fees from Soremartec Italia s.r.l.
chological benefits. Given its favourable impact on
mood, the occasional inclusion of foods that are nutri-
tionally considered “non-optimal” can be acceptable, Funding
provided that the energy intake is compensated The preparation of this document has been supported by an
throughout the rest of the day. unrestricted grant from Danone Italia. The sponsor did not
Morning and afternoon snacks may also ensure have a role in the preparation of the manuscript nor in
that children and adults have sufficient energy to decision to publish the document.
12 F. MARANGONI ET AL.

ORCID Carnell S, Grillot C, Ungredda T, Ellis S, Mehta N, Holst J,

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Daniela Martini http://orcid.org/0000-0001-8298-926X obese individuals with and without binge eating disorder.
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