Magazine 2015
International Peer-Reviewed Journal
RESEARCH HORIZONS, VOL. 5 JULY 2015
ASSOCIATION OF SNACK CONSUMPTION WITH BMI AND
BODY FAT OF PRIMARY SCHOOL CHILDREN IN MUMBAI
Rita Patil, Shobha Udipi
ABSTRACT
The increasing incidence of obesity in adults and children in the world has drawn the attention of all. India
too reports that prevalence of childhood obesity has risen over the past decade. In the recent years,
considerable changes in dietary patterns have caught the attention of all along with the concern for the
rising incidence of obesity. The consumption of high calorie foods, fats, simple sugar and salt has increased
in the diets of adults and children. Mainly due to the wide range of processed and convenience foods
available today. In this context, the present study was undertaken to estimate body mass index (BMI) and
body fat, and to examine the consumption of snacks of children (N=1500). A food frequency questionnaire
was used to record the consumption of snacks with portion sizes per week. Snacks were divided into dry
snacks (wafers, chips, sev etc) and freshly prepared ones (wada pav, Frankie etc). A combined snack
intake was calculated. Consumption of fried snacks in the school cafeteria (canteen) was also studied.
Body Mass Index of the children was calculated. Skin fold measurements were recorded and body fat was
assessed. Data were statistically analysed to assess the relation of snack intake with BMI and body fat. A
significant positive correlation was observed between BMI and a combined snack intake (r=0.237, p=0.000)
and also between consumption of snacks and body fat (r=0.175, p=0.000). The results indicated that
consumption of snacks may influence BMI and body fat.
Key Words : BMI, body fat, children, Cole’s classification, Snack consumption.
Introduction :
The prevalence of overweight and obesity in children has increased in India and is reported by many
researchers (Goyal et al, 2010; Kotian et al, 2010; Aravindalochanan et al., 2012). This increase in overweight/
obesity is attributed to life-style changes which include increased consumption of high fat, high sugar
foods coupled with low physical activity. With the increase in consumption of junk foods/ready to eat
foods/ snacks, vital nutrients in the diets are replaced with excess of fats and sugar(Schmidhuber and
Shetty, 2004; Lukito and Wahlqvist, 2006; Katz, 2011).
The diets of children now a days include several convenience foods and traditional foods seem to be
disappearing from them. Several studies have reported that children eat more junk food like pizzas,
burgers; local fried snacks and even biscuits, chips, pastries etc. (Addleman, 1992; Sharma, 1998; Nicklas
et al., 2003; Wosje et al., 2010). Junk foods are foods which may be high in either all or one of the
following- energy, fat, sugar, preservatives and may be consumed in replacement of meals. The
consumption of junk foods and fried snacks is significantly associated with higher body fat and overweight/
obesity in children (Addleman, 1992; Nicklas et al., 2001; WHO, 2002; Duyff, 2006; Wosje et al., 2010).
In view of this, the present study examined the consumption of snacks by children and their association
with BMI, skinfold thickness and body fat.
Methodology :
One thousand and five hundred, 6-9 years old children studying in twelve primary schools (government-
aided and private) in Mumbai city constituted the study sample. Informed consent was taken from the
School Principals and parents of participating children. The study was approved by the Inter Systems
Biomedical Ethics Committee (ISBEC), Mumbai. All children studying in the primary section of the selected
school were included. Only children who were absent from school on the day of data collection were
excluded.
Data Collection :
Anthropometric measurements: Height was recorded to the nearest 0.1 cm. Weight was measured using
an electronic scale to the nearest 100g. All measurements were taken in triplicate. Body Mass Index
(
BMI) was calculated. Children were classified as underweight, normal weight, overweight and obese
based on Cole’s classification (Cole et al., 2000)
Skinfold Measurements: Skinfold thicknesses at biceps, triceps, suprailiac and subscapular sites were
measured using the Harpenden skinfold caliper. Percent body fat was calculated using the equation
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given by Slaughter et al., (1988). Slaughter’s equation was most suitable for comparison in this study as
their age group of children was closest to the age group of the present study. Also, total skin fold
measure at triceps and sub scapular was observed to be less than 35mm, similar to Slaughter’s study.
Dietary Pattern: Snack consumption of all children was examined using a food frequency questionnaire.
The questionnaire (FFQ) included 210 food items such as cereal preparations, pulse foods, fruits,
vegetables etc. Out of these 55 were popular snacks (dry and fresh). The number of portions and frequency
of consumption was recorded as daily, twice a week, thrice a week, weekly, fortnightly and monthly. The
frequency of eating in the school cafeteria/canteen and portions of snacks consumed was also recorded.
Statistical Analysis: The Statistical Package for Social Science (SPSS) version 20 was used. Analysis of
variance (ANOVA) test and post hoc Bonferroni was done to observe the difference of snack intake in
BMI categories. The difference in body fat indices in quartiles of snack intake was also assessed. Pearson’s
coefficient of correlation was used to testthe association between snack intake, BMI and body fat. Chi
square test was done to observe the distribution of children eating in the canteen.
Results :
Children were classified as underweight, overweight and obese using Cole’s classification. One-fourth
children were overweight/ obese (24.6%), one-third were underweight (30.6%), with less than half the
children having normal weight (44.8%).
More than 90 % children reported a regular intake of snacks. Most of the children who consumed snacks
preferred more dry snacks than fresh ones. The mean consumption of both dry snacks and freshly made
fried snacks was higher than other foods in the FFQ. These were grouped together as combined snacks.
Most of these were fried snacks and were high energy foods.
Minimum 4 to maximum 32 servings of combined snacks were reported to be consumed by children and
the mean intake was 8.7 ± 5.1 portions per week. Girls had a slightly higher combined snack intake (8.9
±
5.2) than did boys (8.5 ± 5.1), but this difference was not significant (F=1.705, p=0.192).
The consumption of fresh snacks was 4.87 ± 2.96 portions per week. Batata wada, samosa, bhajias,
subway, burgers were the most regularly consumed snacks with wada-pav being the favorite snack.
Instant noodles were also reported to be frequently consumed by children of all age groups. Instant
noodles consumption was at least once a week.
The consumption of dry snacks by all children was 4.93 ± 3.03 portions per week and it was more than
that of fresh snacks. Among the dry snacks, banana wafers followed by potato wafers were consumed
most frequently. Kurkure, chakli and sev were also frequently consumed. Children did not report frequent
and/or high consumption of roasted/puffed snacks like popcorn, chana, peanuts which are otherwise
thought to be a favorite of children.
Canteen snacks mainly included wada pav, samosa and samosa pav, which are all fried snacks. In all age
groups, more than half the children did not eat in the canteen. They carried a tiffin to school. A significantly
higher percentage of younger children ate in the canteen daily. The percentage of 7-8 year old children
eating once a week as well as occasionally was significantly higher as compared to the other age
groups. The frequency of children eating in the canteen in the three age groups is shown in table 1.
Table 1: Frequency of Canteen Snack Consumption among Children across Age Groups
Frequency
Percentage of Children
6
-7 years
7-8 years
51.7
11.6
14.9
3.3
8-9 years
59.7
8
Never
Daily
58.5
21.2
10.6
1.6
1
Once a week
Twice a week
Thrice a week
Occasionally
11.5
5.5
3.1
3.7
7.1
14.9
12.2
2
(
χ = 63.266; p = 0.000).
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Less than 50% children reported eating snacks in the canteen and therefore these were not included in
the combined snack category. As age increased the combined snack intake decreased. Younger children
(6-7 years) consumed more snacks than older children. A significant difference in the intake of snacks in
the three age groups was observed (Figure 1).
Figure 1: Mean Snack Intake in Different Age Groups (F= 7.800, p=0.000)
All snacks, dry, fresh and combined had a significant positive correlation with BMI and body fat(table
2
).Canteen snacks did not show such an association probably because their consumption was much
lesser than that of other snacks.
Mean skinfold measurements and percent body fat were compared between BMI categories (Table 2)
Table 2: Mean Skinfold Measurements and Body Fat in BMI Categories.
Values with different superscripts differ significantly (p<0.05) as indicated by the Bonferroni test.
As nutritional status improved, mean skinfold measurements differed. Mean total percent body fat differed
significantly among the BMI categories. Percentage of body fat increased with increase in BMI. The
difference in percent body fat between consecutive BMI categories was approximately 4 %.
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Table 3: Association between Snack Intake, BMI and Body Fat
Type of snacks
Dry
Body Fat
BMI
r = 0.146, p= 0.000
r = 0.231, p= 0.000
r = 0.175, p= 0.000
r = 0.186, p= 0.000
r = 0.263, p= 0.000
r = 0.237, p= 0.000
Fresh
Combined
Snack intake was compared in the BMI categories (Table 4). It was significantly higher in the overweight
and obese groups compared to the underweight and normal weight children. There was no significant
difference in the consumption of canteen snacks in any of the BMI categories.
Table 4: Snack Intake in BMI Categories
Type of Snacks Underweight Normal Weight Overweight Obese
F, p
a
a
bc
bc
bc
Dry
4.3 ± 2.7
4.2 ± 2.4
7.6 ± 4.2
4.8 ± 2.8
4.5 ± 2.5
8.1 ± 4.2
5.7 ± 3.2
6.2 ± 3.6
5.9 ± 3.6
16.741, 0.000
36.010, 0.000
33.168. 0.000
1.587, 0.191
a
a
bc
Fresh
6.3 ± 3.6
a
a
bc
bc
10.9 ± 6.3
1.76 ± 1.6
Combined
Canteen
10.7 ± 6.3
2.28 ± 1.7
2.17 ± 1.7
2.17 ± 1.7
Mean BMI and body fat parameters were compared in quartiles of combined snack intake. Children who
consumed less than 5 portions of snacks per week had significantly lower BMI, skinfold thicknesses at all
sites and percent body fat than those who consumed more 12 portions per week (Table 5).
Table 5: Quartiles of Snack Intake, Skin Fold Measurements and Body Fat.
Values with different superscripts differ significantly (p<0.05) as indicated by the Bonferroni test
Discussion: Food habits have changed from eating home-made foods to ready to eat/convenience
foods by all age groups. The necessity for food is no longer for only nourishment, it is also an indicator
of lifestyle.
More convenience foods are now available leading to increased consumption of bread, biscuits,
chocolates, and snacks like sev, farsan, wafers, ready-to-eat foods as well as various fast foods. A wide
range of snacks are prepared and available in the market today. The intake of these foods has increased
due to easy availability. As more and more women are working, these have become easy and convenient
substitutes for home cooked food. Children are particularly attracted to these foods and are easily
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accepting such dietary changes. Earlier this change was seen with respect to snacks but more recently,
convenience foods have begun to replace meals (Gopalan, 1998; Sharma, 1998; Kapur and Sethi,
2
003). The present study also observed that snack intake was more than staple food intake, fruits and
vegetables.
Therefore, today diets are high in fats, simple sugars, salt, preservatives and missing in fiber and other
necessary vitamins and minerals. Most snacks have a high fat content and they are high energy foods.
Fats add flavor and palatability to food making fried foods (snacks) or high fat foods desirable (Enas
et al., 2003). They are concentrated source of energy and help to increase the energy density of diets
without increasing dietary bulk. Bakery products like cakes, biscuits, breads, cookies and fried savory
items like chips, namkeen, patties, tikkis, samosa, as well as chocolates contain trans fatty acids
(
Skeaff, 2009). Trans fatty acids improve texture, firmness and shelf life of these food products.
Consumption of foods high in fat will lead to adiposity, dyslipidemia, hypertension, CVD and diabetes.
The intake of trans fatty acids should be minimal as they affect serum lipids, decreases HDL- C levels
and increases the risk of coronary heart disease (Harnack et al., 2003). Trans fatty acids are fat which
harden arteries and increase the risk of CHD. Consumption of saturated fats also are a cause of
atherosclerosis as they lead to increased triglyceride levels (Enas et al., 2003). Cardiovascular diseases
are increasing in India and 25% mortality is linked to CVD (Rastogi et al., 2004). In India, the incidence
of non-communicable diseases has increased with life-style disorders such as diabetes being identified
in children as well as adults (Gopalan, 2006; Misra et al, 2009; Singhal et al, 2010).The present study
reports higher BMI and body fat when the snack intake was most. Thus indicating that children may be
at a risk of developing non-communicable diseases earlier in life.
In USA a study reported that consumption of soft drinks, flavored drinks, sweets, candies and fried
snacks had a positive association with overweight. The portions of snacks consumed were also
significantly and positively associated with overweight (Nicklas et al., 2003). Kapur and Sethi (2003)
have reported that 90 % of 7-12 year old children in their study had the habit of snacking. Obese
children preferred snacks which were low in fibre and highin energy, like fries and burgers. In the
present study, frequency of eating fried snacks was higher among obese children compared to those
with normal weight. A similar observation was seen in this study. Rajwade (2007) and Paricharak
(
2010) have observed that that consumption of different types of fried snacks (batata wada, samosa),
pizza, burgers and instant noodles was frequent and at least once a week. Even if these foods are
eaten once a week, they contribute extra calories which increase the risk of overweight and obesity in
children. Similar findings were observed in the present study.
Conclusion: With the wide variety of packaged snacks easily accessible in the market, consumption
of snacks is much higher than before. It is important to keep the balance of eating healthy foods and
less of high calorie, high fat foods particularly when incidence of obesity is rising in all age groups.
Prevention of childhood obesity is crucial in order to help children have good quality of life and avoid
the risk of non-communicable diseases later in life. Thus establishing healthy eating behaviors in children
will help keep them healthy.
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Acknowledgements: The authors thank the schools and children who participated in the study. We
would also like to thank Dr J.C. Sharma for his assistance in the statistical analysis of the data.
Conflict of Interest: The authors declare no conflict of interest related to the contents of this article.
Dr. RIta Patil, Associate Professor & Head Dept.of Food & Nutrition, Maniben Nanavati Women’s College,
Mumbai.
Prof. Dr. Shobha Udipi, Dept. of Food Science & Nutrition, S.N.D.T. Women’s University, Mumbai.
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