Characterizing Children's Eating Patterns: Does the Choice of Eating Occasion Definition Matter?

Abstract Objectives Currently, there are recommendations to defining eating occasions (EO) for use in studies of adults, but none exist for children or adolescents. This study examined how varying definitions of EO influence the characterization of eating patterns in children and adolescents. Methods Cross-sectional 24-h dietary recall data collected during the 2011–12 Australian National Nutrition and Physical Activity Survey (n = 2701, age range: 2–18 years) were analyzed. Eight definitions were applied: participant-identified, time-of-day, and 6 neutral definitions (individual EO separated by 15- or 60-min and/or an additional energy criterion of 5 kcal or 50 kcal). Frequency of and total energy intake from meals, snacks, and all EO were estimated. Differences between definitions were tested using F tests, stratified by sex and age-group. Agreement between definitions of meal and snack frequencies was assessed using intraclass correlation coefficients (ICC). For each definition, linear regression was used to estimate the proportion of variance in total energy intake (kcal) and BMI z-score predicted by frequency of meals and snacks and all EO. Results In boys and girls and across all age groups, mean frequencies of meals and snacks differed between the participant-identified and time-of-day definitions (P < 0.01). There were differences between mean frequencies of EO across the 6 neutral definitions with the largest mean difference observed for children aged 2–3 y (boys: 2.3, girls: 2.5; P < 0.003). There was good agreement (ICC) for snacks (boys: 0.93, girls: 0.93) but not meal frequencies (boys: 0.36; girls: 0.38) between the participant-identified and time-of-day definitions. The definition of 15-min time interval plus 210 kJ consistently predicted the most variance in total energy intake (R2 range = 8.1–34.8). Generally, definitions that delineated meals and snacks best predicted variance in BMI z-score. Conclusions Variations in the definition of EO affect how eating patterns are characterized, particularly in young children. A variation of the neutral definition best predicted variance in total energy intake and findings for BMI were mixed. Further research that compares EO definitions in younger and older children is needed to inform a standard approach. Funding Sources National Heart Foundation of Australia; National Health and Medical Research Council.