Snack Food, Satiety, and Weight

Abstract

In today's society, snacking contributes close to one-third of daily energy intake, with many snacks consisting of energy-dense and nutrient-poor foods. Choices made with regard to snacking are affected by a multitude of factors on individual, social, and environmental levels. Social norms, for example, that emphasize healthful eating are likely to increase the intake of nutrient-rich snacks. In addition, satiety, the feeling of fullness that persists after eating, is an important factor in suppressing overconsumption, which can lead to overweight and obesity. Thus, eating snacks between meals has the potential to promote satiety and suppress overconsumption at the subsequent meal. Numerous studies have explored the relation between snack foods and satiety. These studies concluded that whole foods high in protein, fiber, and whole grains (e.g., nuts, yogurt, prunes, and popcorn) enhance satiety when consumed as snacks. Other foods that are processed to include protein, fiber, or complex carbohydrates might also facilitate satiety when consumed as snacks. However, studies that examined the effects of snack foods on obesity did not always account for satiety and the dietary quality and portion size of the snacks consumed. Thus, the evidence concerning the effects of snack foods on obesity has been mixed, with a number of interventional and observational studies not finding a link between snack foods and increased weight status. Although further prospective studies are warranted to conclusively determine the effects of snack foods on obesity risk, the consumption of healthful snacks likely affects satiety and promotes appetite control, which could reduce obesity.

Full text

REVIEW
Snack Food, Satiety, and Weight
1–3
Valentine Yanchou Njike,
4,5
* Teresa M Smith,
6
Omree Shuval,
7
Kerem Shuval,
8
Ingrid Edshteyn,
5
Vahid Kalantari,
4
and Amy L Yaroch
6
4
Yale University Prevention Research Center and
5
Griffin Hospital, Derby, CT;
6
The Gretchen Swanson Center for Nutrition, Omaha, NE;
7
Flexible
Minds, Rotterdam, Netherlands; and
8
American Cancer Society, Atlanta, GA
ABSTRACT
In today’s society, snacking contributes close to one-third of daily energy intake, with many snacks consisting of energy-dense and nutrient-poor
foods. Choices made with regard to snacking are affected by a multitude of factors on individual, social, and environmental levels. Social norms,
for example, that emphasize healthful eating are likely to increase the intake of nutrient-rich snacks. In addition, satiety, the feeling of fullness that
persists after eating, is an important factor in suppressing overconsumption, which can lead to overweight and obesity. Thus, eating snacks
between meals has the potential to promote satiety and suppress overconsumption at the subsequent meal. Numerous studies have explored
the relation between snack foods and satiety. These studies concluded that whole foods high in protein, fiber, and whole grains (e.g., nuts,
yogurt, prunes, and popcorn) enhance satiety when consumed as snacks. Other foods that are processed to include protein, fiber, or complex
carbohydrates might also facilitate satiety when consumed as snacks. However, studies that examined the effects of snack foods on obesity did
not always account for satiety and the dietary quality and portion size of the snacks consumed. Thus, the evidence concerning the effects of
snack foods on obesity has been mixed, with a number of interventional and observational studies not finding a link between snack foods and
increased weight status. Although further prospective studies are warranted to conclusively determine the effects of snack foods on obesity risk,
the consumption of healthful snacks likely affects satiety and promotes appetite control, which could reduce obesity. Adv Nutr 2016;7:866–78.
Keywords: snack food, satiety, energy density, nutrient density, overweight
Background
Snacking is often defined as consuming a food or drink be-
tween regular meals; however, this definition varies some-
what, with some studies defining specific periods of time
after a meal (e.g., 15 min) and others specifying the amounts
of food (e.g., portion sizes smaller than regular meals) or
calories consumed (1–3). However, irrespective of the vari-
ations in the definition of snacking, it is important to differ-
entiate between snacks and meals to examine their specific
role in daily energy intake and their impact on health (1).
In addition, categorization of the healthfulness of snacks has
not been consistent across studies. Nevertheless, there is con-
sensus that nutrient-poor and energy-dense snacks should be
regarded as unhealthful (4, 5). The healthfulness of snacks
can be determined on the basis of their contents being consis-
tent with established dietary recommendations and guidelines
(6, 7), which promote diets consisting of more fruit, vegetables,
and whole grains and less total fat (especially solid fats), sodium,
and refined sugars. Yet, despite a general interest in the idea of
consuming more healthful foods and snacks among the popu-
lation (8), ready-to-eat highly processed snacks are both in-
creasingly available and consumed (6, 9, 10).
Indeed, snacking constitutes ;27% of children’s daily
caloric intake and there has been a significant increase in
snacking habits over the past several decades (3, 11). Specif-
ically, in 2006, children consumed 1.1 more snacks/d, with
the amount of each snack increasing by ;50 g, in compar-
ison to 1977, with a transition toward greater consump-
tion of salty and candy-like snacks (3). Similarly, among
US adults, the number of daily snacking occasions increased
by ;1 snack/d from 1997 to 2006 (11). Thus, because snacks
are pervasive in today’s society, with energy-dense snacks
and snacks of low dietary quality linked to increased risk
of obesity and cardiovascular disease (3, 11), it is paramount
to investigate factors contributing to snacking behaviors. Al-
though previous research has assessed the literature on
snacking and its effects on health (12), in the current review
we aim to comprehensively examine particular aspects of the
phenomenon of snacking by investigating factors that affect
1
This article is a review from the poster session Snacking, Satiety, & Weight: A Randomized,
Controlled Trial presented at the Advances & Controversies in Clinical Nutrition Conference
held 4–6 December 2014 in National Harbor, MD. The conference was jointly provided by
the American Society for Nutrition (ASN) and Tufts University School of Medicine.
2
The authors reported no funding received for this article.
3
Author disclosures: VY Njike, TM Smith, O Shuval, K Shuval, I Edshteyn, V Kalantari, and AL
Yaroch, no conflicts of interest.
*To whom correspondence should be addressed. E-mail: valentine.njike@yalegriffinprc.org.
866 ã2016 American Society for Nutrition. Adv Nutr 2016;7:866–78; doi:10.3945/an.115.009340.

snacking behavior (including psychological and physiologic
approaches) as well as the effects of various snack foods on
weight. The current study aims to provide a comprehensive
(although not systematic) review on the following 3 main
topics: 1) determinants of snacking, 2) snack food and sati-
ety, and 3) snack food and body weight.
Determinants of Snacking
Food choices in general, and snacking in particular, are
influenced by a multitude of factors. The National Heart,
Lung, and Blood Institute describes a wide array of factors
that affect individual health behavior on the basis of the so-
cioecological model; these consist of factors on the personal,
social and cultural, organizational, environmental, and
policy levels (13). On the personal level, both biological
and demographic (e.g., age, sex, genes) and psychological
(e.g., emotions, self-efficacy, knowledge) factors affect eating
behavior (13). For example, Wouters et al. (14) found that
snacking and soft drink intake was more prevalent in boys
and less-educated youth. In addition, emotional eaters and
individuals under psychological stress have been found to
consume higher amounts of energy-dense snacks, particularly
sweet and fatty snacks (15). Moreover, knowledge about
healthful snacks and self-efficacy in choosing the “right”
snacks are important determinants of snacking behavior
(16). Furthermore, variations in genes are responsible for an
individual’s taste receptors, which, in turn, affect taste percep-
tion and thus food and snack preferences (17). On the social
and cultural level, factors such as modeling behaviors fromthe
family and social norms are related to snacking behavior. Rhee
et al. (18), for example, found that restrictive feeding practices
by parents were related to decreased snack consumption
among children (18), whereas Robinson et al. (19) observed
that messages that emphasize that the social norm is to limit
junk food significantly reduced the intake of high-calorie
snacks (19). In addition, organizational factors and the physical
environment also affect snacking behaviors (13). For example,
lack of access to fresh fruit and vegetables in many low-income
ethnic minority neighborhoods limits residents’ability to con-
sume these healthful snacks (20). Conversely, the abundance of
convenience stores in low-income neighborhoods, which often
contain numerous unhealthful snacks, adversely affects the
nutrition quality of ethnic minority populations (21).
In addition, specific properties of the snacks consumed
as well as an individual’s perception of these snacks are likely
to affect snacking behavior and may lead to overeating. Specif-
ically, over the years, package sizes of snacks have markedly in-
creased (22–24). This increase in package size (11) has directly
influenced total energy intake, regardless of the individual’s
state of hunger or the liking and palatability of the snack (22).
In addition, when distracted (e.g., by watching television
or a movie), individuals often overconsume and are not nec-
essarily cognizant of the dietary quality and quantity of the
snacks eaten (25). Moreover, the energy density of snacks
has also increased (11), which also affects total caloric intake
and dietary quality (26). Although decreasing the package
size can affect the quantity of unhealthful snacks consumed,
increasing the portion size of less palatable healthful snacks
(e.g., a larger bowl of raw vegetables) may actually facilitate
healthful eating (25).
Furthermore, the variety of available snacks influences
how much people consume. From an evolutionary perspec-
tive, humans historically consumed a wide variety of foods
in relatively small quantities to obtain a diversity of required
nutrients, vitamins, and minerals while limiting the amount
of toxins in the foods (27, 28). However, in today’s society,
increased variety has been shown to increase food consump-
tion both during an eating occasion (e.g., at a birthday party
or wedding) and across meals (29, 30). Remick et al. (27) re-
ferred to this as the “variety effect,”which is regulated by
sensory-specific satiety (i.e., the palatability of a specific
food gradually declines as the food is eaten) (26) and
monotony (i.e., the liking of a food decreases in response
to food repetition across meals). Thus the “variety effect”re-
flects human reaction to the sensory aspects of foods
rather than their nutritional properties (i.e., energy density,
volume, and macronutrient composition). For example,
Raynor and Epstein (31) found that when participants ate
a highly palatable snack 4 times/wk for 8 wk, their hedonic
ratings (i.e., the extent to which the snack tasted pleasant)
decreased. This poses a particular challenge to consumers
when exposed to the ubiquity and overabundance of highly
processed snacks that offer variety on the basis of added fat,
sugar, salt, and spices (28).
Snack Foods and Satiety
Satiety, the feeling of fullness that persists after eating, is an
important factor in suppressing overconsumption, which
can lead to overweight and obesity (32). Identifying eating
patterns and foods that promote satiety without consider-
ably increasing overall energy intake is important for pro-
moting more healthful eating behaviors (32, 33). Eating
snacks between meals can potentially promote satiety and
suppress overconsumption at the next meal, although the
literature has explored this phenomenon in certain foods
and nutrients and, to our knowledge, has not yet examined
the collective findings (34). A 2011 study developed a biobe-
havioral approach to assess whether objective criteria for
eating a meal and snacking could be determined through
multiple small substudies and found that, although snacks
in general exerted a weak satiety effect, snacks higher in pro-
tein, compared with those with a higher carbohydrate or
higher fat content, had the strongest satiety effect (1). Al-
though it is important to consider the findings from this
particular study, multiple studies have found satiating effects
of a variety of foods and nutrients consumed as snacks.
Protein content of snack foods. The majority of studies
that considered snacking satiety examined the protein con-
tent of foods, especially protein-rich foods, such as nuts,
dairy, yogurt, and soy. Some studies considered the protein
compared with the carbohydrate content of snacks. Specifi-
cally, Marmonier et al. (35) examined the effects of the nu-
trient composition of an afternoon snack consumed while
Snacks, satiety, and weight 867

not hungry on how soon the next meal was consumed. The
sample of young men were given a high-fat, high-protein,
or high-carbohydrate snack to be consumed 4 h after the be-
ginning of lunch. The consumption of the high-protein
snack delayed the request for dinner by the greatest length
of time, followed by the high-carbohydrate, and then the
high-fat snack. Findings from this study support the notion
that a high-protein snack has the highest satiety compared
with snacks high in other nutrients. Another study assessed
the behavioral consequences of a high-protein snack com-
pared with a high-carbohydrate snack consumed just under
4 h after lunch to investigate whether snacking when not hun-
gry could contribute to obesity (35). Compared with a session
in which no snack was consumed, the high-protein snack de-
layed the dinner request, but the high-carbohydrate snack did
not, which also supports the notion that high-protein snacks
may have the strongest ability to influence satiety. In con-
trast, another study explored how replacing wheat flour in
a soft pretzel with soy ingredients could affect satiety, as
well as other outcomes, but found that the soy addition did
not affect satiety (36).
Although it is interesting to look simply at comparisons
of nutrient content in snacks, multiple studies have consid-
ered how whole foods (e.g., nuts and yogurt) affect satiety. A
review by Tan and Mattes (37) found that tree nuts and pea-
nuts have high satiety values, as well as many other positive
energy-balance attributes, when consumed as snacks (38). A
different review article concluded that pistachios also have
satiety and satiation effects when consumed as a snack
(39). A 4-wk randomized parallel-arm study found that,
when consumed as snacks, almonds reduced hunger and de-
sire to eat during an acute-feeding session, leading the au-
thors to suggest that almonds may be a healthful snack
option (37). However, Alper and Mattes (38) found that,
despite being energy-dense, peanuts have a high satiety value
and chronic ingestion evokes strong dietary compensation
and little change in energy balance (38). A different study
compared almonds with a more conventional snack (cereal
bars) on hunger rating (40). Compared with the control
(who were not provided with snacks and were asked to con-
tinue with their habitual eating pattern) and cereal bar
groups, the almond snack group had a significantly higher
eating frequency, although this did not result in higher en-
ergy intake, body weight, or percentage of body fat. How-
ever, there was no difference in hunger ratings across the 3
groups. For the most part, results indicated that nuts appear
to promote satiety when eaten as a snack.
The satiating effect of yogurt as a snack has also been
explored in multiple studies. One recent study in women
sought to determine whether a high-protein afternoon
yogurt snack improved satiety, among other outcomes
(41). The authors found that, compared with high-fat snacks,
the consumption of yogurt significantly improved satiety
among a sample of healthy women. Another study also con-
ducted in women used an acute randomized crossover-design
study in which participants were given a low-protein or
high-protein yogurt 3 h after lunch (41). Perceived hunger
and fullness were assessed throughout the afternoon until
dinner was voluntarily requested. Snacking led to reduced
hunger and increased fullness, although no differences in
postsnack perceived hunger or fullness were observed be-
tween the low-protein and high-protein yogurt snacks (41).
A third study found that an afternoon snack of Greek yogurt
containing 24 g protein led to significantly reduced hunger,
increased fullness, and delayed subsequent eating than did
lower-protein snacks in healthy women (42). A fourth study
observed that compared with other dairy products (e.g., milk
and cheese), yogurt had a significantly greater effect on sup-
pressing subjective appetite ratings but did not affect subse-
quent food intake (43). Overall, results indicate that yogurt
also appears to promote satiety when eaten as a snack.
Fiber content of snack foods. Many studies that have inves-
tigated the satiety effects of snacking have done so by exam-
ining the fiber content of foods. However, like protein,
some explored the effect of adding fiber to processed food
products, whereas other studies looked at whole foods.
Almiron-Roig et al. (44) considered the addition of fiber
to a yogurtdrink and found that it tended to be more satiating
than the other foods. In another study in which fiber was
added to a food, 20 healthy adolescents were selected and ran-
domly assigned to receive a preload of barley enriched with
b-glucan or control biscuits as a midmorning snack (45). A
decrease in the desire to eat and an increase in fullness and sa-
tiety were experienced with the barley b-glucan–enriched
biscuits compared with the control biscuits. Another study
looked at the effect of psyllium and oat bran on postprandial
glycemia and in vitro digestibility (46). The authors of this
study found that the addition of psyllium fiber to extruded
snack products reduced glycemic responses compared with
a control snack. They also observed that the inclusion of
oat bran in the snack products appeared to extend the glycemic
response compared with the control snack, which suggested
the possibility of prolonged glucose release that potentially
affected satiety responses.
Two studies considered how fibrous whole foods may re-
late to satiety when consumed as snacks. One study exam-
ined prunes consumed as a snack before a meal compared
with an isoenergetic bread product of equal weight (33).
Participants’feeling of hunger, desire, and motivation to
eat were lower at all time points between snack and meals.
Because the macronutrient content of both foods was sim-
ilar in this study, the satiating power of prunes could be due
to their relatively high fiber content. The authors con-
cluded that prunes as a snack appeared to promote satiety
and contributed valuable nutrients. In another study, the
effects of different snack foods, including dried plums, on
satiety and plasma glucose and hormone responses were as-
sessed (47). In this study, 19 women, after fasting, con-
sumed test foods including dried plums, low-fat cookies,
white bread, and water only, which (with the exception of
water) provided 238 kcal and were similar in total carbohy-
drate, fat, and protein content but differed in fiber and
sugar content. They found that among these women, the
868 Njike et al.

consumption of dried plums as a snack suppressed hunger
relative to a low-fat cookie as evidenced by lower glucose
and/or satiety-regulating hormone concentrations. Overall,
the addition of fiber to foods, as well as foods naturally high
in fiber, appeared to promote satiety.
Other nutrient contents and factors in snack foods. Other
studies that have considered the satiating effects of snacks ex-
amined the types of fat and carbohydrates. One dietary fat–
based study explored the consumption of high–oleic acid
and regular peanuts compared with chips and found no ob-
served differences in perceived satiety (48). Another study ex-
amined the effects of replacement of fat by nonabsorbable fat
on energy intake and on feelings of hunger and satiety (49).
The authors concluded that fat replacement in meals or in
snacks did not result in changes in hunger and satiety ratings
throughout the day. On the basis of these studies, the type of
fat in snacks may not have differing effects on satiety, al-
though these findings are relatively limited and further studies
should explore fat content in snacks.
The types of carbohydrates in snacks and their potential
effect on satiety have also been explored. One study examined
the impact of 2 different cookies on satiety and cardiovascular
risk factors. A fructo-oligosaccharide–enriched cookie pro-
duced greater ratings of satiety than a control cookie, which
showed the potential contribution of fructo-oligosaccharides
to satiety (50). Another study compared short-term satiety
from low-fat popcorn with potato chips, without making
any alterations to their nutrient composition (51). Partici-
pants expressed less hunger, more satisfaction, and lower
estimates of prospective food consumption after 6 cups of
popcorn than after consumption of the potato chips. These
studies suggest that certain carbohydrates, such as whole
grains, may promote satiety when consumed as snacks.
Overall, these studies suggestthatsomewholefoodshighin
protein, fiber, and/or whole grains, such as nuts, yogurt, dried
plums or prunes, and popcorn, may promote satiety when con-
sumed as snacks. Other foods that are processed to include pro-
tein, fiber, or complex carbohydrates may also promote satiety
when consumed as snacks. Promoting these foods as snacks
may contribute to satiety and suppress overconsumption at
the next meal. Table 1 provides a summary of this evidence.
Snack Foods and Body Weight
The imbalance between energy expenditure and energy in-
take that results in a positive energy balance is a contributing
factor to the development of obesity. However, the impact of
specific dietary factors has not been sufficiently examined,
with the contribution of specific types of snacks subject to
controversy (53). To date, observational and interventional
studies have not sufficiently shown a causal relation between
snack food and obesity. In fact, results have been quite
mixed, with various and inconsistent exposures (e.g., types
of snack food) and outcome measures (e.g., BMI compared
with waist circumference) and variations in intervention pe-
riods, study populations, and the quality of the methodology
used in the studies.
Nutrient-dense snack foods and body weight. A random-
ized clinical trial that examined the impact of including ei-
ther a daily dark-chocolate or a nonchocolate snack on
weight and anthropometric measurements in premeno-
pausal women observed that both groups showed decreased
body weight, hip and waist circumference, and fat mass (54).
In comparison, a different randomized trial, over a 12-wk
period, examined the effects of daily consumption of either
cereal or an almond snack in healthy overweight or obese
men (44). Study results showed no increase in energy intake,
body weight, or percentage of body fat in either group (40).
An additional study that focused on lean men examined the
effects of eating isoenergetically dense snacks high in pro-
tein, fat, or carbohydrates, which comprised 30% of daily
energy requirements, in the setting of an ad libitum diet of
fixed nutrient composition (55). In this study, snack compo-
sition did not differentially affect total daily food intake or
energy intake, nor did snacking lead to increased body
weight (56). Another intervention study in normal-weight
adults also suggested the ability to maintain a normal
body weight through accurate compensation after snack
consumption (57). Specifically, after 8 wk of a daily manda-
tory snack that provided 25% of energy requirements, there
were no differences in energy intakes or body composition
across groups who were assigned snacks either with or be-
tween meals and snacks having either a low or high energy
density (58). A recent study by Njike et al. (59) found that
the consumption of nut-based snack bars for 12 wk (compared
with conventional snack bars) did not result in any weight
change; however, they did observe reductions in percentage of
body fat and visceral fat in overweight participants. In addition,
an observational longitudinal study in school-aged children
found that there was no increased risk to move into the over-
weight category on the basis of “snacking”or “junk or conve-
nient”eating patterns (60). However, children who adhered
to dietary guidelines, including intakes of vegetables, fruit,
and unrefined cereal products, had a lower risk of remaining
overweight over time (61).
Energy-dense snack foods and body weight. In the Mon-
itoring Project on Risk Factors for Chronic Diseases
(MORGEN)-EPIC (European Investigation into Cancer
and Nutrition) population-based cohort study, there was
some evidence, albeit inconsistent, that the consumption
of energy-dense snacks (e.g., sweets, cakes, pastries, and sa-
vory snacks) was positively associated with an annual in-
crease in weight among normal- to overweight adults (53).
This relation also held true for children. In another cross-
sectional study, the total amount of foods consumed,
specifically from snacks, was positively associated with
overweight status in children; yet, the odds of being over-
weight were very small (55). This may stem from an inter-
action effect of response inhibition and implicit preference
for snack foods. One study in a group of predominantly
normal-weight women found that those with strong im-
plicit preferences for snack foods and low inhibitory capac-
ity gained the most weight (57). Another mechanism for
Snacks, satiety, and weight 869

TABLE 1 Overview of studies that assessed snack foods and satiety
Study Target population Study design Intervention type Comparison group Results
Almiron-Roig et al. (44) 30 participants, 9 men and 21
women; mean age:
36.6 69.1 y
Randomized crossover
trial
Participants were given 5 preloads
(a fiber-enriched drinking
yogurt, a regular drinking
yogurt, plain crackers, fresh
banana, or an isovolumetric
serving of water) over 5
sessions (with a minimum of
2 d between sessions).
Water served as the comparison. Fiber-enriched yogurt was more
satiating than regular yogurt,
banana, crackers, and water. A
trend was suggested, with fiber-
enriched yogurt having the
highest satiating effect followed
by regular yogurt, then banana
and crackers.
Alper and Mattes (38) 15 participants, 7 women
and 8 men; mean age: 33 69y
Crossover intervention
study
Participants were provided
peanuts that equaled ;505 6
118 kcal/d for 8 wk with no
dietary guidance, 3 wk with
instructions to add peanuts to
their customary diet, and 8 wk
in which peanuts replaced an
equal amount of other fats in
the diet.
The period of time when
peanuts that equaled ;
505 6118 kcal/d were
provided for 8 wk with no
dietary guidance served as
the control.
There were no significant differ-
ences in the mean desire to eat,
mean prospective consumption,
and mean fullness ratings with
regard to the intervention.
However, peanuts had a high
satiety value overall.
Barbour et al. (48) 24 participants, 11 women
and 13 men; mean age:
61 61y
Triple crossover study Participants consumed
isoenergetic amounts of high-
oleic or regular peanuts
(56–84 g) or potato crisps
(60–90 g) over 3 d after an
overnight fast.
Unsalted potato crisps served as
the control food.
No differences in perceived satiety
were observed.
Brennan et al. (46) 12 participants —Participants consumed either a
standard 25-g glucose drink in
which psyllium and oat bran
were incorporated at a 15%
replacement concentration to
flour or a control product.
The control product served as
the comparison.
The inclusion of oat bran into the
snack products extended the
glycemic response of individuals
compared with the control snack,
potentially affecting satiety
responses.
de Luis et al. (50) 38 participants, 9 men and 27
women; mean ages: 45.3 6
16.1 and 50.8 616.2 y,
depending on the subgroup
Double-blind randomized
clinical trial
Participants were randomly
assigned to a test group that
received cookies enriched with
fructo-oligosaccharides or to a
control group that received
cookies with no fructo-
oligosaccharides.
Control cookies served
as the comparison.
After the test meal, the baseline
AUC of the satiety score was
higher with the satiety cookie
than with the control cookie.
Results were similar at follow-up.
Dougkas et al. (43) 40 men; mean age: 32 69 y Randomized crossover
trial
Participants attended 4 sessions
that were 1 wk apart . They
received 3 isoenergetic (841
kJ) and isovolumetric (410 mL)
servings of dairy snacks or
water (control) 120 min after
breakfast.
Water served as the
comparison.
All dairy snacks tested reduced
appetite compared with water.
Hunger ratings were 8%, 10%,
and 24% lower after the intake of
yogurt than after cheese, milk,
and water, respectively.
(Continued)
870 Njike et al.

TABLE 1 (Continued )
Study Target population Study design Intervention type Comparison group Results
Douglas et al. (42) 15 women; mean age: 26 62 y Randomized crossover
study
Participants consumed afternoon
snacks of yogurt with 5, 14,
or 24 g protein, or no snack, for
3 d. On the fourth day, partici-
pants consumed a standard-
ized lunch, and consumed their
yogurt snack 3 h later or did not
consume any snack.
The afternoons of “no snack"
served as the comparison.
The yogurt snack led to reduced
hunger and increased fullness
compared with no snack. Among
the types of snacks, hunger was
lower and fullness was higher
throughout the postsnack period
after the higher-protein yogurt
vs. the lower-protein yogurt.
Furchner-Evanson
et al. (47)
19 women; mean age: 39.2 6
0.7 y
Randomized, balanced
crossover study
Participants consumed test foods
(dried plums, low-fat cookies,
white bread, and water only)
on separate days. The test
foods (except water) provided
238 kcal and were similar in
total carbohydrate, fat, and
protein content, but differed in
fiber and sugar content.
A snack of 220 mL water
served as the comparison.
The satiety index AUC was greater
for the dried plum trial vs. the
low-fat cookie trial.
Marmonier et al. (35) 11 men; mean age: 22.5 60.5 y Within-subject study Participants were given a
high-fat, a high-protein, or a
high-carbohydrate snack that
they were to consume 240 min
after the beginning of lunch.
There was no control group. Consumption of the high-protein
snack delayed the request for
dinner by 60 min, the high-
carbohydrate snack delayed the
dinner request by 34 min, and the
high-fat snack delayed the dinner
request by 25 min.
Marmonier et al. (35) 8 men; mean age: 22.6 60.7 y Within-subject study Participants attended 3 sessions:
1) a basal session, 2) a session in
which they consumed a high-
protein snack, or 3) a session in
which they consumed a high-
carbohydrate snack 215 min
after lunch.
Each participant was his own
control.
Compared with the basal (no snack)
session, the high-protein snack
delayed the spontaneous dinner
request by 38 616 min, but the
high carbohydrate snack did not.
Nguyen et al. (51) 35 participants, 17 men and
18 women; mean age: 33 6
11 y
Counterbalanced within-
subject study
Across 4 trials in a laboratory setting,
participants consumed a stan-
dardized breakfast. They the n
were either gi ven a snack of
1 cup (4 g, 15 kcal) popcorn,
6 cups (27 g, 10 0 kcal) 94%
fat-free microwave popcorn,
or 1 cup (28 g, 150 kcal) potato
chips, each with 200 mL wa ter,
or they received the control
(200 mL water).
Water (200 mL) served as the
comparison.
Participants expressed less hunger,
more satisfaction, and lower esti-
mates of prospective food con-
sumption after 6 cups of popcorn
than after all other treatments.
Popcorn exerted a stronger effect
on short-term satiety than did
potato chips.
(Continued)
Snacks, satiety, and weight 871

TABLE 1 (Continued )
Study Target population Study design Intervention type Comparison group Results
Ortinau et al. (41) 20 women; mean age: 27 62 y Randomized crossover
design study
Participants participated in three
8-h testing days comparing
three 160-kcal afternoon
snacks: high-protein yogurt,
high-fat crackers, and high-
fat chocolate.
The high-fat snacks served as
the comparison.
The consumption of the yogurt
snack led to greater reductions in
afternoon hunger, but not full-
ness, vs. chocolate. The yogurt
snack also delayed the request of
dinner by 30 min compared with
the chocolate snack.
Ortinau et al. (52) 32 women; mean age: 27 62 y Acute randomized cross-
over study
Participants consumed yogurt
with either 5 or 14 g protein
3 h after consuming a
standardized lunch. They then
reported perceived hunger
and fullness throughout the
afternoon until dinner was
voluntarily requested.
The yogurt with 5 g protein
served as the comparison.
Snacking led to reductions in hun-
ger and increases in fullness, al-
though there were no differences
in postsnack-perceived hunger or
fullness between the 2 types of
yogurt.
Simmons et al. (36) 20 participants, 8 men and
12 women; mean age: 25.3 6
6.4 y
Randomized, counterbal-
anced, crossover study
Participants ate either a soy
pretzel or wheat pretzel.
The wheat pretzel served as the
comparison group.
The mean satiety score was 306.2 6
215.0 cm 3min for wheat vs.
311.3 6201.0 cm 3min for the
soy pretzel (P= 0.92). Soy did not
have any effect on satiety in this
study.
Tan and Mattes (37) 137 participants, 48 men and
89 women; mean ages ranged
from 27.8 610.7 to 32.9 611.5 y,
depending on the subgroup
Randomized, controlled,
parallel-arm study
Participants were assigned to 1
of 5 groups: control, breakfast,
lunch, morning snack, after-
noon snack. Participants in
the morning snack group were
instructed to consume 43 g
almonds as a morning snack
for 4 wk. Participants in the
afternoon snack group were
instructed to consume 43 g
almonds between lunch and
dinner, with $2 h before and
after these meals.
Participants in the control group
were asked to avoid all nuts
and seeds during the study
period.
Postprandial “hunger”and “desire to
eat”ratings were significantly less
for the combined snack groups
than for the combined meal and
control groups (P= 0.026 and P=
0.023, respectively).
Vitaglione et al. (45) 20 participants, 10 men and
10 women; mean age: 18 6
0.5 y
—Participants received a 628-kJ
or a 1884-kJ preload of barley
β-glucan–enriched or control
biscuits as a midmorning
snack.
The control biscuits served as
the comparison.
A decrease in the AUC of the desire
to eat and an increase in the AUC
of fullness and satiety were
recorded with a small preload of
barley β-glucan–enriched biscuit
compared with a small preload of
control biscuit.
(Continued)
872 Njike et al.

this effect might stem from increased portion size, because
increasing portions by 50% was found to increase daily
energy intake by 16% and increasing portion size by
100% increased energy intake by 26% (60). Given the re-
sults as a whole, it is hard to conclude that snacking leads
to increased energy intake or compensation. Another lon-
gitudinal study, which followed nonobese premenarchal
girls, found that energy-dense snacks did not influence
weight-status change over the adolescent period; specifi-
cally, soda was the only energy-dense snack that was sig-
nificantly related to BMI zscore over the 10-y study
period (62). In a prospective study of both girls and
boys, snack foods considered to be of low nutritional value
were not an important independent determinant of weight
gain among children and adolescents (5). Specifically, a
null relation between the number of snack servings per
day and subsequent changes in BMI zscore was observed
(5). Interestingly, another cross-sectional study in over-
weight and normal-weight adolescents observed that
although overweight adolescents had more irregular
meals, which may play a role in developing excess weight,
they snacked significantly less often than did adolescents
with a normal BMI (63). Other longitudinal studies have
not found a clear and positive association between child-
hood obesity development and the behavior of snacking
but did find an association with sugar-sweetened beverage
consumption (63).
Snack foods, energy intake, and body weight. Although
some findings suggest that the relation of eating fre-
quency with BMI zscore differs from that of changes in
BMI (65), obesity-related eating behaviors, such as the
number of eating occasions, have been considered for
their contribution to higher energy intake. In a cross-
sectional study, however, no association was found be-
tween the number of obesity-related eating behaviors
and food portion size or the number of eating occasions
but the number of obesity-related eating behaviors was asso-
ciated with higher consumption of sugary and alcoholic bev-
erages (66). Thus, these studies suggest that there may not be
a link between snacking and overweight status in adults or
adolescents and that the type of snack consumed is an impor-
tant determinant that should be taken into account. In com-
parison, other studies suggested that some snack foods may
indeed lead to increased energy intake and weight gain. In
a crossover trial, participants partially compensated for en-
ergy when supplemented with commercial snack products
over 14-d periods, but this compensation was insufficient
to prevent some increase in energy balance, resulting in
body-weight gain (49, 57).
On the basis of these studies, the effects of snack foods on
body weight are mixed. Studies that used nutrient-dense
snack foods were associated with weight loss or weight
maintenance, whereas those that used energy-dense snack
foods were associated with weight gain or had no effects
on body weight. Table 2 summarizes the evidence on the
impact of snack foods on body weight.
TABLE 1 (Continued )
Study Target population Study design Intervention type Comparison group Results
Westerterp-Plantenga
et al.
(49)
48 women; mean ages ranged
from 21.0 60.7 to 33.4 69.5 y,
depending on the subgroup
Experimental design study Participants received snacks that
they could consume ad
libitum and recorded food in-
take for 2 wk. In the first week,
all snacks were full fat, and in
the second week only half were
full fat whereas the others were
in reduced-fat reduced-energy
form, and labeled as such.
—Fat replacement in meals or in
snacks did not result in changes
in hunger and satiety ratings
throughout the day. These results
suggest short-term beneficial
effects of fat replacement on
energy and fat intake.
Zaveri and Drummond
(40)
36 men; mean age: 39.6 66.9 y Randomized controlled
trial
Participants were given 2
packets of cereal bars (30 g and
high in carbohydrates) or al-
monds (28 g and high in pro-
tein) for 12 wk. They were free
to eat the snacks at any time.
The control group did not
receive the cereal bar or al-
monds and were asked to
continue their habitual eating
pattern.
Hunger did not significantly differ at
baseline, 6 wk, or 12 wk between
almond, cereal bar, and control
groups.
Snacks, satiety, and weight 873

TABLE 2 Overview of studies that assessed snack foods and body weight
1
Study Target population Study design Intervention type Comparison group Results
Evans et al. (65) Urban schoolchildren, ages 9–15 y Cross-sectional and
prospective study
Eating frequency, the average
number of reported daily eat-
ing occasions, was assessed
by using 2 weekday 24-h diet
recalls.
Normal BMI zscore From baseline to 6 mo, BMIz
increased by 0.03 units for
each additional reported eating
occasion. This relation was
no longer significant at 1 y.
Field et al. (5) Boys and girls between ages 9
and 14 y
Prospective cohort study Intake of snack foods was as-
sessed in 1996–1998 with a
validated FFQ designed
specifically for children and
adolescents.
No control group There was no relation between
intake of snack foods and
weight gain.
Hendriksen et al. (53) Normal-weight and overweight
Dutch adults
Prospective cohort study Intake of EDS foods (sweets, cakes,
and pastries and savory snacks)
was assessed at baseline by
using a validated FFQ.
Lowest tertile of EDS food
consumption
Inconsistent evidence of an asso-
ciation of EDS food consump-
tion with annual weight
change.
Jodkowska et al. (63) Polish overweight and normal-
weight adolescents, aged
13–15 y, of whom 953 were
overweight and 953 had
normal body mass
Cross-sectional analysis Self-reported questionnaire
containing questions regarding
how often selected food pro-
ducts were usually consumed
during the week, how
regularly basic meals (breakfast,
lunch, supper) were eaten, and
data on snacking.
“Selection in pairs,”each over-
weight pupil was paired with
a pupil with normal body
weight
Overweight adolescents con-
sumed unhealthy products
such as sweets and crisps sig-
nificantly less often than their
peers with appropriate body
mass. Overweight girls ate dark
bread significantly more often,
and consumed soft drinks less
often, than their peers with
normal weight. Nevertheless,
overweight teenagers snacked
significantly less often than
young people with normal
body mass.
Johnstone et al. (56) 8 British men with ad libitum
access to a diet of fixed
composition
Randomized controlled
crossover design
1) Mandatory snacks
compared with snacks and 2)
the composition of isoener-
getically dense snacks high in
protein, fat, or carbohydrate on
food and energy intakes.
No snack group Body weight was not affected by
snacking.
Moreno and Rodriguez (64) Children and adolescents Review Dietary aspects influencing
obesity development
Review Longitudinal studies have only
found a clear and positive as-
sociation between obesity
development and sugar-
sweetened beverage con-
sumption; this is not the case
with snacking, fast food, or
food portion sizes.
(Continued)
874 Njike et al.

TABLE 2 (Continued )
Study Target population Study design Intervention type Comparison group Results
Muñoz-Pareja et al. (66) 10,791 persons representative of
the Spanish population who
were $18 y old in 2008–
2010
Cross-sectional study Self-reported information was
collected on 12 OREBs
Participants with #1 OREB OREBs were associated with
higher food energy density and
higher consumption of sugary
and alcoholic beverages.
Nederkoorn et al. (57) Normal-weight undergraduate
female students over a 1-y
period
Longitudinal prospec-
tive cohort study
Implicit preference for food, re-
sponse inhibition and BMI
were measured.
Low implicit food preference Participants with strong implicit
preferences for snack foods and
low inhibitory capacity gained
the most weight.
Nicklas et al. (55) 1562 children aged 10 y (65%
EA, 35% AA) over a 21-y period
Cross-sectional analysis No intervention was delivered. No comparison group Food consumed from snacks was
positively associated with over-
weight status.
Njike et al. (59) 34 overweight adult participants Randomized controlled
trial
Participants were provided nut-
based snack bars to
consume daily for 12 wk.
Conventional snack bar, specifi-
cally empty-calorie snack
bar
Body fat and visceral fat were
reduced and there were no
adverse effects on weight,
blood pressure, lipid profile,
satiety, or quality of life.
Oellingrath et al. (61) Primary-school children from
Norway; middle childhood
(fourth grade, 9–10 y old) to
early adolescence (seventh
grade, 12–13 y old).
Prospective cohort,
cross-sectional, and
longitudinal
analysis
Categorization into 4 eating
patterns: snacking, junk or
convenient, varied Norwegian,
and dieting
Unchanged normal-weight
child
Children with stable or increased
“varied Norwegian”pattern
scores had a lower risk of re-
maining overweight over time
than children with decreased
scores for this pattern.
Piehowski et al. (54) Premenopausal overweight
women with BMIs (in kg/m
2
)
of 25–43
Randomized controlled
trial, 18 wk
Reduced-calorie diet including
either a daily dark-chocolate
snack or a nonchocolate
snack
Nonchocolate snack group Women in both the dark-
chocolate snack and
nonchocolate snack groups
experienced decreases in body
weight (25.1 vs. 25.1 kg), hip
circumference (25.8 vs. 25.4
cm), waist circumference (25.7
vs. 23.5 cm), fat mass (23.9 vs.
23.6 kg), and body fat per-
centage (23.4% vs. 23.1%),
respectively, with no change in
lean mass.
Phillips et al. (62) Nonobese premenarchal girls 8–
12 y old were enrolled
between 1990 and 1993 and
followed until 4 y after
menarche
Prospective cohort study Relation between EDS foods
and relative weight change
No control group There was no relation between
BMIz or %BF and total EDS food
consumption. Soda was the
only EDS food that was
significantly related to BMIz
over the 10-y study period.
(Continued)
Snacks, satiety, and weight 875

Summary and Conclusions
Although efforts have been put forth to examine the effects
of snack foods on satiety and weight status, to our knowl-
edge the association between snack foods and body weight
has not been sufficiently summarized to date. In addition,
studies on the topic used various study designs (ranging
from cross-sectional to randomized controlled trials) and
often had methodologic limitations. For the intervention
studies, the intervention duration as well as the timing of
the introduction of the snack food varied; specifically,
some studies advised participants to consume the snack
food between meals whereas others advised participants to
snack as needed. The intervention studies included in this
review were primarily short term. The type of snack foods
that were used in the various studies also varied; some stud-
ies used snack foods that were high in protein and/or fiber,
whereas others used snacks that were high in fat and/or
sugar. In addition, the sample sizes of participants in the in-
cluded studies were small, and the composition of the con-
trol groups was inconsistent across studies, with some
studies lacking a control group altogether. In addition, the
variation in the dietary patterns of participants makes it dif-
ficult to interpret the findings. Yet, this inherent variation in
dietary patterns in the study participants is also a strength
because it is similar to a real-world scenario, in which die-
tary patterns and habits vary. Although the findings of the
studies that evaluated the impact of nutrient-dense snacks
that are higher in protein and fiber showed weight reduction
or weight maintenance, the findings of the studies that as-
sessed the impact of low-nutritional-value snacks (e.g.,
sugar-sweetened beverages, sweets, cakes, pastries, pizza,
and savory foods) were conflicting. Specifically, some studies
showed weight gain, whereas others found no weight gain.
In summary, this review suggests that the judicious selec-
tion of snack foods has the potential to contribute valuable
nutrients to the daily diet. Furthermore, snack foods have
the potential to contribute to satiety, with higher-protein
snack foods having the strongest effect. For example, the
consumption of high-protein, high-fiber snack foods can
lead to reduced caloric intake at a subsequent meal when
compared with high-fat, high-sugar snack foods. Conse-
quently, thoughtful selection of snack foods may contribute
to body-weight maintenance or reduction. However, when
considering all of the aforementioned methodologic limita-
tions in these studies and the conflicting results it is hard to
reach a decisive conclusion on the impact on snack foods on
weight status. Larger long-term multisite intervention trials
that take into consideration the time of consumption of the
snack foods are warranted to elucidate the impact of snack
foods on both satiety and body weight. In addition, mecha-
nistic studies are warranted to understand the underpin-
ning mechanism or mechanisms through which the various
snack foods affect body weight.
Acknowledgments
All authors read and approved the final manuscript.
TABLE 2 (Continued )
Study Target population Study design Intervention type Comparison group Results
Viskaal-van Dongen et al. (58) 16 men and 66 women (mean
age: 21.9 y), mean BMI
(in kg/m
2
): 20.7
Randomized controlled
trial, 8 wk
Randomly assigned to 1 of 4 par-
allel groups in a 2 32 design:
snacks consumed with or be-
tween meals and snacks having
a low (,4 kJ/g) or high (.12
kJ/g) energy density. For 8 wk,
subjects consumed mandatory
snacks that provided 25% of
energy requirements on each
day.
High energy–density snack food No differences in changes in body
weight between the 4 groups.
Similarly, there were no differ-
ences in changes in body
composition, PAL, and energy
intake between the 4 groups.
1
AA, African American; BMIz, standardized BMI zscore; EA, Euro-American; EDS, energy-dense snack; OREB, obesity-related eating behavior; PAL, physical activity level; %BF, percentage of body fat.
876 Njike et al.

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