Evidence suggests that the transition to postsecondary may be an important period of risk for engagement in disordered eating (DE). DE has been demonstrated to fluctuate and change course over time, however, very little research has examined factors that underlie these changes in DE. Higher negative urgency has been associated with elevated DE frequency, and preliminary evidence suggests that negative urgency may change concurrently with DE symptoms. Moreover, symptoms of depression, anxiety, and stress (DAS), are all associated with DE engagement, implicating an important role for negative affect in DE engagement. Despite this evidence, there is a paucity of literature examining the association between negative urgency and DE frequency over time, and how acute negative emotional states may moderate this relationship. The current study aimed to address this research gap by examining the association between negative urgency and DE frequency over time, and if symptoms of DAS moderate this relationship. It was hypothesized that DE frequency and negative urgency would share a significantly coupled relationship, and that symptoms of DAS would significantly moderate this relationship. Specifically, negative urgency would be more strongly coupled with DE frequency when DAS symptoms were high, as compared to when DAS symptoms were low. Two cohorts of first year undergraduate students (N = 645) completed monthly self-reports of negative urgency, symptoms of DAS, and DE frequency over their first two semesters of post-secondary study (7 months total). Multilevel Models revealed that indeed negative urgency and DE frequency share a statistically significant coupled relationship over time (p < .001), and that depressive symptoms moderate this relationship (p < .001) such that the coupled association between negative urgency and DE frequency was strengthened by depression. The current study is the first to examine how negative urgency and DE frequency co-vary over time and how negative affect moderates this association. The results illuminate the importance of considering interactions between established risk factors and negative emotional states in the engagement and frequency of DE behaviours, and offers preliminary insight into correlates of change in DE frequency over time. / Graduate

Background: The relationship between eating frequency (EF) and adiposity is surrounded by controversy. Numerous cross-sectional studies have been performed on the subject, yet the results are mixed. While some of these studies show an inverse relationship between EF and adiposity, this is likely due to underreporting of EF and total energy intake when diets are self-reported. In studies where underreporting was taken into account, EF is positively associated with both energy intake and adiposity. Intervention trials have failed to show a significant effect of EF on energy intake or weight change, but only a small number exist. Objective: In this study, we examined associations among EF, energy intake, and adiposity in free living adults consuming self-selected diets. In conducting this analysis, two common methodological problems in this research area were addressed: 1) the lack of consideration of energy balance fluctuations throughout the day, and 2) a tendency not to account for implausible reporting of energy intake. We hypothesized that individuals with higher EF would have higher BMI, percentage body fat, and energy intake. Additionally individuals with greater fluctuations in energy balance will have higher BMI, percentage body fat, and EF. Methods: We performed a secondary analysis of data collected as part of a previous study in our laboratory on diet and energy regulation (unpublished). One hundred and twenty-six participants were enrolled (62.4 % female, and 75.2% Caucasian), and one participant dropped the study due to pregnancy. Mean ±SD age, BMI, and percentage body fat of the remaining 125 participants were 29.8 ±12.2 years, 24.5±3.9 kg/m2, and 27.8±9.8% respectively. We analyzed one day of dietary intake collected using a multiple pass 24 hour recall. Energy intake was calculated by NDS (Nutrition Data System for Research, version 2011 (n=36) and version 2010 (n=89)). An eating occasion was defined as any occurrence of energy intake > 0 kcal separated by at least 1 hour. EF was defined as the number of eating occasions per day. A specifically designed spreadsheet that generates within-day energy balance was used to produce estimates of hourly energy balance. We also used total energy expenditure measured by doubly labeled water and the Huang et al. (2005)1 method to identify implausible reporters (cutoff for plausibility was reported energy intake (REI) within ±16.8% of TEE) and conducted Pearson’s correlations and regression analysis in both the total sample and a subsample in which implausible energy intake reporters were excluded from analysis. Results: We identified 59.2% of the sample as implausible reporters (n=74; 47 under-reported and 27 over-reported). Mean ±SD EF and energy intake were 4.7±1.5 and 2356±964 kcal in the total sample and 4.8±1.6 and 2371±689 kcal in the plausible sample. In the total sample EF was positively correlated to energy intake among women (r=0.244, p=0.032). No other significant relationships were observed between EF and either energy intake, BMI, or percentage body fat, in the total or plausible sample. In the total sample, maximum energy deficit > 400 kcal in a 24 hours period was significantly and positively correlated with percentage body fat (r=0.211,p=0.019) and negatively correlated with EF (r=-0.243, p=0.007) when controlling for sex and age. Separating the sample by sex we observed significant positive correlation between percentage body fat and maximum energy deficit in men (r=0.382, p=0.009) but not in women. No significant relationships between fluctuations in energy balance and percentage body fat were observed in the plausible sample. Conclusion: No evidence was found to suggest a relationship between EF and adiposity. The significant positive relationships observed between maximum energy deficit and adiposity in the total sample are consistent with previous findings. The number of implausible reporters identified in our analysis supports that over and under-reporting is a major issue associated with self-reporting of dietary intake.

Improved weight loss interventions are needed to help reduce obesity. One dietary factor that has been effective in increasing weight loss is increased dietary structure. One method for increasing dietary structure is prescribing the frequency in which eating bouts (meals and snacks) occur. Eating frequency (EF) has been inversely related to body mass index (BMI) but the impact of EF on weight loss is unclear. This randomized controlled trial examined the effect of EF on hunger, the relative-reinforcing value of food, energy intake (EI), and weight loss during a 6 month behavioral weight loss intervention. Participants (age: 51.0 ± 9.9 yrs, BMI: 35.5 ± 4.8 kg/m2, 57.8% female, 94.1% white) were randomized to one of two EF prescriptions: 1) Three Meal (n=25): three eating bouts/day; or 2) Grazing (n=26): eat at least 100 kcals every 2-3 hrs. Both groups attended 20 sessions and had identical dietary (1200–1500 kcals/day, < 30% kcals from fat) and physical activity (200 minutes/wk) goals. Hunger, relative-reinforcing value of food, diet, and anthropometric data were collected at 0 and 6 months. Using intent-to-treat analyses, Grazing reported a greater EF (eating bouts in which > 25 kcals were eaten/day) than Three Meal at 6 months (5.8 ± 1.1 eating bouts vs. 3.2 ± 0.6 eating bouts, p<0.001). On a 100-mm visual analogue scale Grazing reported significantly less hunger at 6 months as compared to 0 months (47.9 ± 18.5 mm vs. 56.3 ± 15.7 mm, p<0.05), while Three Meal did not report any changes. There were no significant differences in the relative-reinforcing value of food between groups or over time. EI and BMI were significantly (p<0.001) reduced from 0 to 6 months (EI: 0 months = 2198 ± 692 kcals/day vs. 6 months = 1266 ± 353 kcals/day; BMI: 0 months = 35.5 ± 4.8 kg/m2 vs. 6 months = 30.6 ± 4.9 kg/m2). There were no significant differences in EI or BMI between the groups. An EF of approximately six eating bouts/day may decrease hunger more so than an EF of three meals/day while consuming a low-kcal diet during a behavioral weight loss intervention.

Introdução: As contribuições do tamanho das porções dos alimentos e do número de refeições realizadas por dia para o aumento da prevalência do excesso de peso e para alterações no perfil lipídico em populações consumindo dieta ad libitum ainda não são bem estabelecidas, visto que a literatura apresenta resultados contraditórios. Objetivo: Avaliar a associação entre porções dos alimentos e o número de refeições realizadas com o excesso de peso e o perfil lipídico de adultos e idosos residentes do município de São Paulo. Métodos: Foram utilizados dados do estudo transversal de base populacional ISA - Capital 2008, referentes à amostra probabilística de residentes do município de São Paulo com 20 anos ou mais, de ambos os sexos. As informações, como dados socioeconômicos, antropométricos, de estilo de vida e inquérito alimentar, foram coletadas entre 2008 e 2010 por meio de visitas domiciliares e inquérito telefônico. No primeiro manuscrito da presente dissertação, os 1042 indivíduos foram classificados segundo o Índice de Massa Corporal (IMC) em duas categorias: com e sem excesso de peso. Dados de consumo alimentar foram obtidos por dois recordatórios alimentares de 24 horas (R24h). Os alimentos citados foram classificados em grupos e avaliados. Foi calculada a mediana da porção, percentual de relato e contribuição energética para homens e mulheres com e sem excesso de peso. Modelos de regressão logística foram utilizados para avaliar a associação entre o tamanho das porções de alimentos e o excesso de peso. No segundo manuscrito, foram utilizadas informações de 521 adultos e idosos que possuíam dados do perfil lipídico e o segundo R24h e não utilizavam hipocolesterolêmicos. Os indivíduos foram categorizados de acordo com o número de refeições realizadas ao longo de um dia: menos que três; três; mais que três refeições. Medianas e intervalos interquartis foram utilizados para descrever variáveis contínuas não-paramétricas e testes de tendência e Kruskal-Wallis foram utilizados para comparar esses valores entre as categorias de número de refeições. 9 Frequências das variáveis categóricas foram descritas e comparadas por testes quiquadrado de Pearson. Modelos lineares generalizados foram utilizados para avaliar a associação entre número de refeições e excesso de peso e, também, para ajustar as variáveis lipídicas segundo variáveis de confundimento, como IMC, idade, entre outras. As médias dos preditos gerados a partir dos modelos de cada uma das variáveis lipídicas foram comparadas entre as categorias de número de refeições por análise de variância e teste de tendência. Resultados: Foram observadas associações positivas entre o excesso de peso e os tamanhos de porção dos seguintes alimentos: arroz (p=0,003), bolos (p=0,050), pães (p=0,028), pizza (p=0,008) e salgados (p=0,012) após o ajuste pelas variáveis de controle. Menores valores de IMC (p=0,013) e de circunferência de cintura (p=0,004) foram observados nos indivíduos que consomem mais que três refeições por dia em relação aos que consomem menos que três. O consumo energético aumentou (p=0,001) enquanto a densidade energética da dieta diminuiu (phomens=0,01; pmulheres=0,032) com o aumento da categoria de refeições. Entre as mulheres, foram observados valores maiores de TG (p=0,038) e menores de HDL-col (p=0,049) na categoria que consome até três refeições. Conclusões: O tamanho da porção de alguns grupos de alimentos foi associado positivamente ao excesso de peso, enquanto nenhum grupo de alimento de baixa densidade energética foi relacionado inversamente. O número de refeições associou-se inversamente ao IMC e à circunferência de cintura na população estudada quando a ingestão energética se manteve constante. Contudo, o perfil lipídico apresentou-se melhor apenas no sexo feminino, quando o número de refeições foi maior. O controle do tamanho da porção de determinados alimentos e do número de refeições pode auxiliar na prevenção e controle do excesso de peso. / Introduction: The contribution of food portion sizes and eating frequency to the rising prevalence of overweight and to lipid profile changes in populations consuming ad libitum diet is not well established, as contradictory results are presented in literature. Objective: Verify the association between food portion sizes, eating frequency, being overweight and lipid profile in a representative population sample of adults and elderly in São Paulo. Methods: The study considered data from cross-sectional population-based ISA-Capital 2008 with random sample of residents of São Paulo aged above 20 years and both sexes. Socioeconomic, anthropometric, lifestyle and diet information was collected between 2008 and 2010 in personal or phone interviews. In the first article of this dissertation, 1042 individuals were classified according to Body Mass Index (BMI) into two categories: with and without excess body weight. Food consumption data were obtained by two 24-hour food recall (R24h). The reported foods were classified into groups and evaluated. The median portion, reported percentage and energy contribution for men and women with and without EBW were calculated. Logistic Regression models were used to evaluate the association of food portion sizes with being overweight. In the second article, data from 521 adults and elderly who had information about lipid profile, the second R24h and did not use hipocolesterolemics were used. Individuals were classified according to eating frequency: less than three; three; more than three meals a day. Medians and interquartile ranges were used to describe non-parametric continuous variables and trend tests and Kruskal-Wallis were used to compare data across eating frequency categories. Pearson chi-squared tests were used to compare frequencies of categorical variables. General Linear Models were used to evaluate the association between eating frequency and being overweight and also to adjust the lipid variables according to confounding variables, as BMI and age. The means of 11 predicts generated from each model of the lipid variables were compared across eating frequency categories using variance analysis and trend tests. Results: Positive associations were observed between overweight and the food groups: rice (p=0.003), cakes (p=0.050), breads (p=0.028), pizza (p=0.008), and salted snacks (p=0.012) after adjusting for control variables. Individuals consuming more than three meals a day presented lower values of BMI (p=0.013) and waist circumference (p=0.004) comparing to those consuming less than three meals a day. Energy intake increased (p=0.001) while energy density of the diet decreased (pmen=0.01; pwomen=0.032) when increasing the categories of eating frequency. Women consuming less than three meals a day presented higher values of triglycerides (p=0.038) and lower values of high density lipoprotein (p=0.049) than the others. Conclusions: The portion size of some food groups was positively associated with being overweight, while none of the food groups with low energy density was negatively associated. Eating frequency was positively associated with BMI and waist circumference in this population when energy intake was constant. Lipid profile was better only for women, when eating frequency was higher. Controlling the portion size of certain foods and eating frequency can help to prevent and control excess body weight.

Introdução: As contribuições do tamanho das porções dos alimentos e do número de refeições realizadas por dia para o aumento da prevalência do excesso de peso e para alterações no perfil lipídico em populações consumindo dieta ad libitum ainda não são bem estabelecidas, visto que a literatura apresenta resultados contraditórios. Objetivo: Avaliar a associação entre porções dos alimentos e o número de refeições realizadas com o excesso de peso e o perfil lipídico de adultos e idosos residentes do município de São Paulo. Métodos: Foram utilizados dados do estudo transversal de base populacional ISA - Capital 2008, referentes à amostra probabilística de residentes do município de São Paulo com 20 anos ou mais, de ambos os sexos. As informações, como dados socioeconômicos, antropométricos, de estilo de vida e inquérito alimentar, foram coletadas entre 2008 e 2010 por meio de visitas domiciliares e inquérito telefônico. No primeiro manuscrito da presente dissertação, os 1042 indivíduos foram classificados segundo o Índice de Massa Corporal (IMC) em duas categorias: com e sem excesso de peso. Dados de consumo alimentar foram obtidos por dois recordatórios alimentares de 24 horas (R24h). Os alimentos citados foram classificados em grupos e avaliados. Foi calculada a mediana da porção, percentual de relato e contribuição energética para homens e mulheres com e sem excesso de peso. Modelos de regressão logística foram utilizados para avaliar a associação entre o tamanho das porções de alimentos e o excesso de peso. No segundo manuscrito, foram utilizadas informações de 521 adultos e idosos que possuíam dados do perfil lipídico e o segundo R24h e não utilizavam hipocolesterolêmicos. Os indivíduos foram categorizados de acordo com o número de refeições realizadas ao longo de um dia: menos que três; três; mais que três refeições. Medianas e intervalos interquartis foram utilizados para descrever variáveis contínuas não-paramétricas e testes de tendência e Kruskal-Wallis foram utilizados para comparar esses valores entre as categorias de número de refeições. 9 Frequências das variáveis categóricas foram descritas e comparadas por testes quiquadrado de Pearson. Modelos lineares generalizados foram utilizados para avaliar a associação entre número de refeições e excesso de peso e, também, para ajustar as variáveis lipídicas segundo variáveis de confundimento, como IMC, idade, entre outras. As médias dos preditos gerados a partir dos modelos de cada uma das variáveis lipídicas foram comparadas entre as categorias de número de refeições por análise de variância e teste de tendência. Resultados: Foram observadas associações positivas entre o excesso de peso e os tamanhos de porção dos seguintes alimentos: arroz (p=0,003), bolos (p=0,050), pães (p=0,028), pizza (p=0,008) e salgados (p=0,012) após o ajuste pelas variáveis de controle. Menores valores de IMC (p=0,013) e de circunferência de cintura (p=0,004) foram observados nos indivíduos que consomem mais que três refeições por dia em relação aos que consomem menos que três. O consumo energético aumentou (p=0,001) enquanto a densidade energética da dieta diminuiu (phomens=0,01; pmulheres=0,032) com o aumento da categoria de refeições. Entre as mulheres, foram observados valores maiores de TG (p=0,038) e menores de HDL-col (p=0,049) na categoria que consome até três refeições. Conclusões: O tamanho da porção de alguns grupos de alimentos foi associado positivamente ao excesso de peso, enquanto nenhum grupo de alimento de baixa densidade energética foi relacionado inversamente. O número de refeições associou-se inversamente ao IMC e à circunferência de cintura na população estudada quando a ingestão energética se manteve constante. Contudo, o perfil lipídico apresentou-se melhor apenas no sexo feminino, quando o número de refeições foi maior. O controle do tamanho da porção de determinados alimentos e do número de refeições pode auxiliar na prevenção e controle do excesso de peso. / Introduction: The contribution of food portion sizes and eating frequency to the rising prevalence of overweight and to lipid profile changes in populations consuming ad libitum diet is not well established, as contradictory results are presented in literature. Objective: Verify the association between food portion sizes, eating frequency, being overweight and lipid profile in a representative population sample of adults and elderly in São Paulo. Methods: The study considered data from cross-sectional population-based ISA-Capital 2008 with random sample of residents of São Paulo aged above 20 years and both sexes. Socioeconomic, anthropometric, lifestyle and diet information was collected between 2008 and 2010 in personal or phone interviews. In the first article of this dissertation, 1042 individuals were classified according to Body Mass Index (BMI) into two categories: with and without excess body weight. Food consumption data were obtained by two 24-hour food recall (R24h). The reported foods were classified into groups and evaluated. The median portion, reported percentage and energy contribution for men and women with and without EBW were calculated. Logistic Regression models were used to evaluate the association of food portion sizes with being overweight. In the second article, data from 521 adults and elderly who had information about lipid profile, the second R24h and did not use hipocolesterolemics were used. Individuals were classified according to eating frequency: less than three; three; more than three meals a day. Medians and interquartile ranges were used to describe non-parametric continuous variables and trend tests and Kruskal-Wallis were used to compare data across eating frequency categories. Pearson chi-squared tests were used to compare frequencies of categorical variables. General Linear Models were used to evaluate the association between eating frequency and being overweight and also to adjust the lipid variables according to confounding variables, as BMI and age. The means of 11 predicts generated from each model of the lipid variables were compared across eating frequency categories using variance analysis and trend tests. Results: Positive associations were observed between overweight and the food groups: rice (p=0.003), cakes (p=0.050), breads (p=0.028), pizza (p=0.008), and salted snacks (p=0.012) after adjusting for control variables. Individuals consuming more than three meals a day presented lower values of BMI (p=0.013) and waist circumference (p=0.004) comparing to those consuming less than three meals a day. Energy intake increased (p=0.001) while energy density of the diet decreased (pmen=0.01; pwomen=0.032) when increasing the categories of eating frequency. Women consuming less than three meals a day presented higher values of triglycerides (p=0.038) and lower values of high density lipoprotein (p=0.049) than the others. Conclusions: The portion size of some food groups was positively associated with being overweight, while none of the food groups with low energy density was negatively associated. Eating frequency was positively associated with BMI and waist circumference in this population when energy intake was constant. Lipid profile was better only for women, when eating frequency was higher. Controlling the portion size of certain foods and eating frequency can help to prevent and control excess body weight.

Fractionner son alimentation consiste à augmenter la fréquence de ses prises alimentaires, sans modifier la quantité totale d’énergie ingérée. Dans ce travail de thèse, nous avons étudié les effets du fractionnement alimentaire sur l’appétit et la balance énergétique chez des sujets de poids normal et obèses. Le premier objectif était d’ordre méthodologique : nous avons proposé et validé un dispositif original d’étude de l’appétit, basé sur la duplication du même protocole dans deux lieux de recherche différents et sur l’utilisation d’un restaurant expérimental, en reproduisant une situation écologique de repas. Ce dispositif permet de répondre à deux enjeux méthodologiques. D’une part, il permet une approche intégrée de l’appétit, grâce à l’association de mesures subjectives (sensations de faim et de satiété), physiologiques (biomarqueurs de l’appétit : ghréline et GLP-1) et comportementales (consommations, choix et rythmes alimentaires). D’autre part, le caractère écologique de la situation de repas proposée assure une bonne validité externe des résultats. Le second objectif était d’étudier, grâce à cette méthodologie, les conséquences à court terme du fractionnement alimentaire sur les sensations de faim, les hormones qui régulent l’appétit, le comportement au cours du repas qui suit le fractionnement, ainsi que sur les orientations métaboliques. Chez des sujets de poids normal, les approches subjectives, physiologiques et comportementales ont toutes montré une diminution de l’appétit en réponse au fractionnement. En revanche, nous n’avons pas obtenu les mêmes bénéfices comportementaux chez les obèses, chez qui le fractionnement n’a pas induit de baisse des apports énergétiques au cours du repas suivant. Sur le plan métabolique, nous avons montré les mêmes effets dans les deux populations, à savoir une insulinémie maintenue au-dessus de son niveau basal, entraînant une inhibition prolongée de la lipolyse, elle-même caractérisée par une baisse des concentrations plasmatiques en acides gras non estérifiés. Le fractionnement a également entrainé une diminution de la dépense énergétique via la thermogénèse alimentaire. Ce travail met en évidence les bénéfices possibles du fractionnement alimentaire chez les personnes de poids normal pour mieux contrôler leur appétit. En revanche, cette stratégie ne semble pas adaptée pour des personnes obèses. Les effets sur la dépense énergétique et les orientations métaboliques, potentiellement négatifs, doivent être étudiés sur de plus longues périodes / This thesis project consists in studying the effects of eating smaller more frequent meals, with no change in energy intake, on appetite and energy balance in normal weight and obese subjects. The first objective was methodological: we proposed and validated an original methodology for studying appetite, based on the duplication of the same protocol in two different research centers, and the use of an experimental restaurant, reproducing an ecological meal situation. This methodology enables to answer two methodological issues. Firstly, it allows an integrated approach of appetite, associating subjective (hunger and satiety feelings), physiological (biomarkers of appetite: ghrelin and GLP -1) and behavioral (food intake, choices and eating rhythms) measurements. Secondly, the ecological character of the eating situation we proposed, ensure a good external validity of the results. The second objective was to assess, thanks to this methodology, the short term consequences of eating smaller more frequent meals on subjective appetite, on hormones that regulates appetite, on eating behaviors during the subsequent meal, and on metabolic orientations. In normal weight subjects, subjective, physiological and behavioral approaches showed a decrease in appetite after eating smaller more frequent meals, while in obese subjects we did not obtain the same beneficial behaviors: obese subjects did not consume less energy during the subsequent meal. Metabolic results showed the same effects in both normal weight and obese subjects: insulin concentrations were maintained above their basal level, leading to an extended inhibition of lipolysis, characterized by a decrease in plasmatic concentrations of non-esterified fatty acids. Eating smaller more frequent meals also decreased energy expenditure via diet induced thermogenesis. This work highlights the fact that eating smaller more frequent meals may be beneficial in normal weight individuals in order to better control appetite, but it does not seem to be an adequate strategy in obese individuals. The effects on energy expenditure and metabolic orientations, potentially negative, should be studied over a longer period

The objective of this study was to understand the influence of eating episodes and snack quality on body weight of children ages 3-4.9 years participating in the Broward County Special Supplementation Nutrition Program for Women, Infants, and Children (WIC).Additional objectives were to evaluate obesity risk factors and to examine the effect of childcare arrangements on body weight. Data was collected from 7 Broward County Health Department WIC clinics over 4 months via a researcher-administered questionnaire. Additional data was extracted from the WIC data system. BMI-for-age percentiles were used to categorize children by weight according to Centers for Disease Control (CDC) guidelines, which were further categorized into under/normal weight and overweight/obese. There were 197 participants included (45.7% boys), 3.6% of the children were underweight, 64.4% normal weight, 16.8% overweight, and 15.2% were obese. Most children consumed 3 meals (97.5%) and 2 to 3 snacks per day (33.0% and 37.1% respectively), with a significantly higher intake of snacks on the weekends when compared to weekdays (p=0.001). Children consumed more nutritious snacks more often (66%) than the nutrient-poor snacks (33.5%). We observed a marginally significant trend in which the WIC preschool children that more frequently consumed nutrient-poor snacks had a higher prevalence of overweight/obesity (p=0.090). In multivariate analyses, the children who consumed more than 4-oz of sugar sweetened beverages (SSB) per day, exercised for less than 1 hour per day, and had a higher birth weight had increased odds of being overweight/obese. Race and ethnicity were not predictive of body weight status, but Blacks or African Americans were at a higher risk for many of the risk factors. Children spent on average 20 hours per week under some type of nonparental care arrangement. There was no significant relationship between childcare and weight status. Our findings indicate that WIC children are at a greater risk for overweight and obesity, however there is potential for successful prevention interventions addressing prevalent risk factors. Longitudinal studies including a large sample of racial and ethnic diverse preschool children from low socioeconomic families could help elucidate the results from our study. This study was approved by FIU IRB (Protocol Approval #15-0369) the State of Florida Department of Health IRB (Protocol Title: Meal Frequency and the Role of Snacking on Weight of Minority Preschool Children).