Environmental Influences on Dietary Intake of Children and Adolescents Printed Edition of the Special Issue Published in Nutrients www.mdpi.com/journal/nutrients Jessica Sophia Gubbels Edited by Environmental Influences on Dietary Intake of Children and Adolescents Environmental Influences on Dietary Intake of Children and Adolescents Special Issue Editor Jessica Sophia Gubbels MDPI • Basel • Beijing • Wuhan • Barcelona • Belgrade • Manchester • Tokyo • Cluj • Tianjin Special Issue Editor Jessica Sophia Gubbels Maastricht University The Netherlands Editorial Office MDPI St. Alban-Anlage 66 4052 Basel, Switzerland This is a reprint of articles from the Special Issue published online in the open access journal Nutrients (ISSN 2072-6643) (available at: https://www.mdpi.com/journal/nutrients/special issues/ Environmental Influences Dietary Intake?authAll=true). For citation purposes, cite each article independently as indicated on the article page online and as indicated below: LastName, A.A.; LastName, B.B.; LastName, C.C. Article Title. Journal Name Year , Article Number , Page Range. ISBN 978-3-03936-533-3 ( H bk) ISBN 978-3-03936-534-0 (PDF) c © 2020 by the authors. Articles in this book are Open Access and distributed under the Creative Commons Attribution (CC BY) license, which allows users to download, copy and build upon published articles, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. The book as a whole is distributed by MDPI under the terms and conditions of the Creative Commons license CC BY-NC-ND. Contents About the Special Issue Editor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Jessica S. Gubbels Environmental Influences on Dietary Intake of Children and Adolescents Reprinted from: Nutrients 2020 , 12 , 922, doi:10.3390/nu12040922 . . . . . . . . . . . . . . . . . . . 1 Edward Leigh Gibson, Odysseas Androutsos, Luis Moreno, Paloma Flores-Barrantes, Piotr Socha, Violeta Iotova, Greet Cardon, Ilse De Bourdeaudhuij, Berthold Koletzko, Simona Skripkauskaite, Yannis Manios and on behalf of the Toybox-study Group Influences of Parental Snacking-Related Attitudes, Behaviours and Nutritional Knowledge on Young Children’s Healthy and Unhealthy Snacking: The ToyBox Study Reprinted from: Nutrients 2020 , 12 , 432, doi:10.3390/nu12020432 . . . . . . . . . . . . . . . . . . . 7 Wendy Van Lippevelde, Leentje Vervoort, Jolien Vangeel and Lien Goossens Can Parenting Practices Moderate the Relationship between Reward Sensitivity and Adolescents’ Consumption of Snacks and Sugar-Sweetened Beverages? Reprinted from: Nutrients 2020 , 12 , 178, doi:10.3390/nu12010178 . . . . . . . . . . . . . . . . . . . 25 Yukako Tani, Takeo Fujiwara, Satomi Doi and Aya Isumi Home Cooking and Child Obesity in Japan: Results from the A-CHILD Study Reprinted from: Nutrients 2019 , 11 , 2859, doi:10.3390/nu11122859 . . . . . . . . . . . . . . . . . . 51 Fiona Lavelle, Tony Benson, Lynsey Hollywood, Dawn Surgenor, Amanda McCloat, Elaine Mooney, Martin Caraher and Moira Dean Modern Transference of Domestic Cooking Skills Reprinted from: Nutrients 2019 , 11 , 870, doi:10.3390/nu11040870 . . . . . . . . . . . . . . . . . . . 61 Sacha Verjans-Janssen, Dave Van Kann, Stef Kremers, Steven Vos, Maria Jansen and Sanne Gerards A Cross-Sectional Study on the Relationship between the Family Nutrition Climate and Children’s Nutrition Behavior Reprinted from: Nutrients 2019 , 11 , 2344, doi:10.3390/nu11102344 . . . . . . . . . . . . . . . . . . 75 Liisa Korkalo, Kaija Nissinen, Essi Skaffari, Henna Veps ̈ al ̈ ainen, Reetta Lehto, Riikka Kaukonen, Leena Koivusilta, Nina Sajaniemi, Eva Roos and Maijaliisa Erkkola The Contribution of Preschool Meals to the Diet of Finnish Preschoolers Reprinted from: Nutrients 2019 , 11 , 1531, doi:10.3390/nu11071531 . . . . . . . . . . . . . . . . . . 89 Reetta Lehto, Carola Ray, Liisa Korkalo, Henna Veps ̈ al ̈ ainen, Kaija Nissinen, Leena Koivusilta, Eva Roos and Maijaliisa Erkkola Fruit, Vegetable, and Fibre Intake among Finnish Preschoolers in Relation to Preschool-Level Facilitators and Barriers to Healthy Nutrition Reprinted from: Nutrients 2019 , 11 , 1458, doi:10.3390/nu11071458 . . . . . . . . . . . . . . . . . . 105 Sara E. Benjamin-Neelon, Amelie A. Hecht, Thomas Burgoine and Jean Adams Perceived Barriers to Fruit and Vegetable Gardens in Early Years Settings in England: Results from a Cross-Sectional Survey of Nurseries Reprinted from: Nutrients 2019 , 11 , 2925, doi:10.3390/nu11122925 . . . . . . . . . . . . . . . . . . 119 v Clare E. Holley, Carolynne Mason and Emma Haycraft Opportunities and Challenges Arising from Holiday Clubs Tackling Children’s Hunger in the UK: Pilot Club Leader Perspectives Reprinted from: Nutrients 2019 , 11 , 1237, doi:10.3390/nu11061237 . . . . . . . . . . . . . . . . . . 131 Nina Bartelink, Patricia van Assema, Stef Kremers, Hans Savelberg, Dorus Gevers and Maria Jansen Unravelling the Effects of the Healthy Primary School of the Future: For Whom and Where Is It Effective? Reprinted from: Nutrients 2019 , 11 , 2119, doi:10.3390/nu11092119 . . . . . . . . . . . . . . . . . . 143 Anna Kiss, J ́ ozsef Popp, Judit Ol ́ ah and Zolt ́ an Lakner The Reform of School Catering in Hungary: Anatomy of a Health-Education Attempt Reprinted from: Nutrients 2019 , 11 , 716, doi:10.3390/nu11040716 . . . . . . . . . . . . . . . . . . . 159 Almudena Garrido-Fern ́ andez, Francisca Mar ́ ıa Garc ́ ıa-Padilla, Jos ́ e Luis S ́ anchez-Ramos, Juan G ́ omez-Salgado, Gabriel H. Trav ́ e-Gonz ́ alez and Elena Sosa-Cordob ́ es Food Consumed by High School Students during the School Day Reprinted from: Nutrients 2020 , 12 , 485, doi:10.3390/nu12020485 . . . . . . . . . . . . . . . . . . . 179 Roel C.J. Hermans, Koen Smit, Nina van den Broek, Irma J. Evenhuis and Lydian Veldhuis Adolescents’ Food Purchasing Patterns in the School Food Environment: Examining the Role of Perceived Relationship Support and Maternal Monitoring Reprinted from: Nutrients 2020 , 12 , 733, doi:10.3390/nu12030733 . . . . . . . . . . . . . . . . . . . 197 Rub ́ en Trigueros, Luis A. M ́ ınguez, Jer ́ onimo J. Gonz ́ alez-Bernal, Maha Jahouh, Raul Soto-Camara and Jos ́ e M. Aguilar-Parra Influence of Teaching Style on Physical Education Adolescents’ Motivation and Health-Related Lifestyle Reprinted from: Nutrients 2019 , 11 , 2594, doi:10.3390/nu11112594 . . . . . . . . . . . . . . . . . . 211 Rub ́ en Trigueros, Luis A. M ́ ınguez, Jer ́ onimo J. Gonz ́ alez-Bernal, Jos ́ e M. Aguilar-Parra, Ra ́ ul Soto-C ́ amara, Joaqu ́ ın F. ́ Alvarez and Patricia Rocamora Physical Education Classes as a Precursor to the Mediterranean Diet and the Practice of Physical Activity Reprinted from: Nutrients 2020 , 12 , 239, doi:10.3390/nu12010239 . . . . . . . . . . . . . . . . . . . 225 Julia D ́ ıez, Alba Cebrecos, Alba Rapela, Luisa N. Borrell, Usama Bilal and Manuel Franco Socioeconomic Inequalities in the Retail Food Environment around Schools in a Southern European Context Reprinted from: Nutrients 2019 , 11 , 1511, doi:10.3390/nu11071511 . . . . . . . . . . . . . . . . . . 237 Jaapna Dhillon, L. Karina Diaz Rios, Kaitlyn J. Aldaz, Natalie De La Cruz, Emily Vu, Syed Asad Asghar, Quintin Kuse and Rudy M. Ortiz We Don’t Have a Lot of Healthy Options: Food Environment Perceptions of First-Year, Minority College Students Attending a Food Desert Campus Reprinted from: Nutrients 2019 , 11 , 816, doi:10.3390/nu11040816 . . . . . . . . . . . . . . . . . . . 251 Charlene Elliott Tracking Kids’ Food: Comparing the Nutritional Value and Marketing Appeals of Child-Targeted Supermarket Products Over Time Reprinted from: Nutrients 2019 , 11 , 1850, doi:10.3390/nu11081850 . . . . . . . . . . . . . . . . . . 267 vi Christine D. Czoli, Elise Pauze ́ and Monique Potvin Kent Exposure to Food and Beverage Advertising on Television among Canadian Adolescents, 2011 to 2016 Reprinted from: Nutrients 2020 , 12 , 428, doi:10.3390/nu12020428 . . . . . . . . . . . . . . . . . . . 283 vii About the Special Issue Editor Jessica Sophia Gubbels (PhD). Dr. Jessica Gubbels is an associate professor at the Department of Health Promotion within Maastricht University, the Netherlands. Her research mainly focuses on the (environmental) determinants of health behavior of young children and their families. Most of her projects focus on the influence of parents and childcare. She has a special interest in the interaction between determinants of health behavior. In addition to her research in the European context, she supervises several PhD-projects in developing countries, including Sudan, Lebanon, and Uganda. She also teaches within various programs, including the bachelor programs of Health Sciences, Psychology, and European Public Health, as well as the master program in Health Education and Promotion. She is a frequent keynote speaker at national and international conferences for both practice and research, and is a member of specialist committees of the Dutch Health Council. She has received various prestigious fellowships and grants. ix nutrients Editorial Environmental Influences on Dietary Intake of Children and Adolescents Jessica S. Gubbels Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, NL-6200 MD, Maastricht, The Netherlands; jessica.gubbels@maastrichtuniversity.nl Received: 17 March 2020; Accepted: 19 March 2020; Published: 27 March 2020 Introduction Childhood is a crucial period for establishing lifelong healthy nutritional habits [ 1 ]. The environment can have an important influence on these habits [ 2 ]. According to the ANGELO framework [ 3 ], the environment can be operationalized through distinguishing between four environmental types: The physical environment (what is available), the social environment (what are the attitudes / beliefs of important others), the political environment (what are the rules), and the economic environment (what are the costs) [ 3 ]. The studies described in the current special issue cover these various types of environmental influences within di ff erent settings, including home and school, on children and adolescents’ dietary intake. Several studies in the special issue focused on environmental influences in the home setting. Parents play an important role in forming their children’s dietary habits and are important gatekeepers for children’s behavior [ 4 , 5 ]. Gibson and colleagues [ 6 ] examined parental influences on snacking in preschoolers in a large cross-European sample. Parents’ own snacking behavior and rules about snacking were significantly associated with the intake of their children, but parents’ educational level and nutritional knowledge were also important predictors. Interestingly, the parental influences were di ff erent for healthy and unhealthy snacking [ 6 ]. In an older sample, Van Lippevelde and colleagues [ 7 ] showed that health-promoting parenting practices were associated with reduced sugar sweetened beverage intake and increased healthy snack intake, while health-reducing practices were associated with increased unhealthy snack intake. Van Lippevelde and colleagues [ 7 ] also examined whether the parenting practices moderated the positive relationship between adolescents’ reward sensitivity and unhealthy dietary intake, but this was not the case. Interestingly, they did find indications of such an interaction when using the parent-reported instead of the adolescent-reported parenting practices as a moderator [ 7 ]. This stresses the importance of carefully considering our methodology to assess environmental influences, also taking the child’s perspective of the environment into account [ 8 ]. In addition, Hermans and colleagues [ 9 ] showed that parental influence on adolescents’ dietary intake even reaches beyond the home setting: Support from mothers was positively associated with adolescents bringing healthy products to school, and negatively associated with their purchase of sweet snacks in and around school [9]. Tani, Fujiwara, Doi, and Isumi [ 10 ] examined the association between home cooking and childhood obesity in a large sample of primary school children in Japan. Children living in households with a low frequency of home cooking were more than twice as likely to be obese as those in a household with high cooking frequency were. This association was partially mediated by children’s diet (vegetable, breakfast, and snack intake), suggesting that home cooking is associated with healthy intake, which, in turn, decreases the risk for obesity [ 10 ]. Home cooking and family meals are important indicators of family functioning [ 11 ], and can thus be regarded an important target for future obesity prevention interventions. Transference of cooking skills from parents to their children could be a key aspect in increasing home cooking. Lavelle and colleagues [ 12 ] examined such transference of cooking skills Nutrients 2020 , 12 , 922; doi:10.3390 / nu12040922 www.mdpi.com / journal / nutrients 1 Nutrients 2020 , 12 , 922 in a qualitative study among Irish mothers. Although mothers expressed a desire for teaching their children to cook, various barriers to actually involving children in cooking were identified. These barriers included children’s lack of interest in cooking, clingy behavior and messiness in the kitchen, and pickiness with regard to food. This points out that parents may need some help in dealing with practical barriers to involving their children in the kitchen, as well to motivate their children to actually get involved [12]. In addition to parental influences, increasing attention is being paid to the influence of the broader family system on children’s dietary intake [ 13 ]. In the current special issue, Verjans-Janssen and colleagues [ 14 ] examined the associations between the Family Nutrition Climate—i.e., the family’s shared perceptions and cognitions regarding healthy nutrition [ 15 ]—and dietary intake of primary school children. Several subscales, as well as the total Family Nutrition Scale, were positively associated with healthy intake behaviors, including increased fruit, vegetable, and water intake, and decreased soft drink and sweets intake [ 14 ]. This underlines the importance of the family-level influences in addition to parental influences. Furthermore, parents often share responsibility for caring for their child with (pre)schools and childcare facilities. Whereas the majority of young children in OECD (Organisation for Economic Co-operation and Development)-countries attend some form of preschool or organized childcare [ 16 ], almost all older children and adolescents attend some type of education [ 17 ]. In the current special issue, various papers addressed the influence of care and educational facilities. With regards the youngest children, Korkalo and colleagues [ 18 ] showed that preschool meals contribute to over half of weekday energy intake in young Finnish children. This shows the important influence preschools can have on children’s diets. Preschool meals were relatively healthy, being high in fibers, fish, unsaturated fats, and several vitamins, and low in added sugar. However, fruit consumption at preschool was low and salt intake was relatively high [ 18 ]. These findings point out the specific intake behaviors that need to be addressed in future interventions. In another study from Finland, Lehto and colleagues [ 19 ] examined the association of various facilitators and barriers at preschool, with children’s fruit, vegetable, and fiber intake in those preschools. One of the main predictors of healthy intake was the presence of food policies [ 19 ]. Policies are crucial for the longer-term maintenance of potential intervention e ff ects [ 20 ], preventing that established environmental changes slowly dilute and eventually diminish over time. Surprisingly, the study of Lehto et al. [ 19 ] did not find any influence of center cooking facilities, resources, or sta ff education on children’s intake, which might imply that a lack of resources and facilities does not necessarily hinder healthy dietary intake. Benjamin Neelon and colleagues [ 21 ] also examined barriers to the implementation of intervention in childcare settings, though specifically for fruit and vegetable gardens. Fruit and vegetable garden projects have been previously shown to increase children’s intake of fruit and vegetables (e.g., [ 22 ], but to date few interventions in Early Care and Education settings have included gardening [ 23 ]). Benjamin Neelon and colleagues [ 21 ] showed that although the majority (81%) of the English childcare settings was interested in implementing gardens, various practical barriers hindered actual implementation, including lack of space, expertise and time. This is in line with the findings of Holley and colleagues [ 24 ], who identified various barriers and challenges for free food provision at holiday clubs to tackle children’s hunger. Although reported e ff ects did not only include tackling of hunger, but also creating positive food experiences and promoting social interactions and positive behavior in general, the reported challenges, including resources constraints, hindered implementation [ 24 ]. This indicates that a tailored approach is necessary when implementing intervention approaches, taking into account intermediaries’ needs and barriers, as well as their strengths [25]. Moving on to primary schools, Bartelink and colleagues examined e ff ects of an integrated intervention on children’s diet and physical activity in a large quasi-experimental study in the Netherlands [ 26 ]. They found the intervention to have favorable e ff ects on children’s diet and physical activity. However, the e ff ects on diet were only present when the full intervention was implemented: Schools that skipped the free healthy lunch that was part of the intervention only found e ff ects on 2 Nutrients 2020 , 12 , 922 physical activity. In addition, the intervention showed less favorable e ff ects on younger children and children with a low socioeconomic status (SES). These findings of Bartelink and colleagues [ 26 ] are in line with an ecological systems view of environmental influences on behavior [ 27 – 29 ], which states that environmental influences on diet are context-specific (like children’s SES in the study by Bartelink et al.) as well as person-specific (in line with the diminished e ff ects depending on children’s age in the study). Hence, determinants of behavior cannot be viewed in isolation. They influence each other, and it is their combined influence that determines behavior [ 30 ]. This stresses the importance of a broad, integrative approach in interventions. The findings of Kiss and colleagues [ 31 ] underline this. In their analysis of the reform of the school catering system in Hungary, they showed that changed regulations (i.e., the political environment) are not necessarily translated into action. All involved sectors need to be on board, and interaction and dialogue between stakeholders needs to be facilitated. Furthermore, they stressed that there is no universal solution fitting all settings and all children [ 31 ], in line with the di ff erent e ff ects depending on contextual and person-related factors reported by Bartelink et al. [26]. Diet is also a concern within secondary schools. Garrido-Fern á ndez and colleagues [ 32 ] showed that adolescents were more likely to consume unhealthy snacks when they attended a school with a cafeteria. Hence, while school cafeteria might have large potential to improve children’s diet and prevent overweight [ 33 ], this potential is often not utilized in practice [ 32 ]. In addition to the physical environment at secondary schools, the social environment is also very important. Trigueros and colleagues [ 34 , 35 ] showed that teaching style during Physical Education (PE) classes was associated with Portuguese adolescents’ motivation, which, in turn, was related to their diet and physical activity. Their findings support the Self Determination Theory [ 36 ]: Satisfaction of the basic human psychological needs (autonomy, competence, and relatedness) was crucial for the adolescent’s motivation toward PE classes. Students that were highly motivated consumed more healthy foods and less unhealthy foods and were more active. As such, Trigueros et al. [ 34 , 35 ] provide us with insight into some of the cognitive factors that precede behavioral decisions regarding dietary intake and how the environment can support these cognitive processes. The results can therefore be used by interventions addressing PE classes and teaching styles. Moving from the school setting to the surrounding neighborhood environment, D í ez and colleagues [ 37 ] examined socioeconomic inequalities in the food environment around schools in Spain. They showed that 95% of the schools were surrounded by unhealthy food retailers within a short range, with a median of 17 unhealthy food outlets per school. A worrying addition to this was that unhealthy food retailers were both closer and higher in number for schools in low-SES neighborhoods [ 37 ], indicating that children from a lower SES background are growing up in a less healthy food environment. Dhillon and colleagues [ 38 ] painted an equally problematic picture regarding the food environment of college students living on a food-desert campus in the United States. Performing a qualitative focus group study, they showed that there was a lack of adequate, acceptable, a ff ordable, and accessible food within students’ environment. Healthy foods, such as fruit, were too expensive and often not available at campus, and it was very di ffi cult to get food from outside the campus area [ 38 ]. Based on the studies of D í ez [ 37 ] and Dhillon [ 38 ], we can conclude that both the overwhelming o ff er of unhealthy foods and the lack of healthy foods around educational facilities are very problematic. Within food outlets, the study by Elliott [ 39 ] showed that 88% of Canadian child-targeted products was not suitable for marketing to children. Interestingly, the percentage of children’s products that was unsuitable was stable between 2009 and 2017. At both time points, over 70% of children’s food products was too high in sugar. However, a very large increase in nutrition claims was visible in the observed time period. Also, the use of several marketing techniques aimed at children (e.g., the use of cartoon images and child fonts) increased, while the use of other approaches decreased (e.g., the use of games on the package). The study by Elliott [ 39 ] showed the significant pressure to eat unhealthy foods that is exerted by marketing. In line with this, the findings of Czoli et al. [ 40 ] showed that although overall exposure to food advertisements among Canadian children decreased, advertisements were 3 Nutrients 2020 , 12 , 922 dominated by fast food and sugary drinks. More strict regulation of marketing directed at children and adolescent is therefore urgently needed, which should be directed at the di ff erent settings and media that youngsters encounter. In conclusion, the papers in the current issue underline the importance of the environment in influencing children’s and adolescents’ dietary intake across di ff erent settings and types of environments. 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This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http: // creativecommons.org / licenses / by / 4.0 / ). 6 nutrients Article Influences of Parental Snacking-Related Attitudes, Behaviours and Nutritional Knowledge on Young Children’s Healthy and Unhealthy Snacking: The ToyBox Study Edward Leigh Gibson 1, *, Odysseas Androutsos 2 , Luis Moreno 3,4,5 , Paloma Flores-Barrantes 3,4,5 , Piotr Socha 6 , Violeta Iotova 7 , Greet Cardon 8 , Ilse De Bourdeaudhuij 8 , Berthold Koletzko 9 , Simona Skripkauskaite 1 , Yannis Manios 10 and on behalf of the Toybox-study Group † 1 Department of Psychology, University of Roehampton, London SW15 4JD, UK; s.skripkauskaite@bangor.ac.uk 2 Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece; oandroutsos@uth.gr 3 GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C / Pedro Cerbuna s / n, 50009 Saragossa, Spain; lmoreno@unizar.es (L.M.); pfloresbarrantes@gmail.com (P.F.-B.) 4 Instituto Agroalimentario de Arag ó n (IA2), 50013 Saragossa, Spain 5 Fundaci ó n Instituto de Investigaci ó n Sanitaria Arag ó n (IIS Arag ó n), 50009 Saragossa, Spain 6 The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; p.socha@ipczd.pl 7 Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria; violeta.iotova@mu-varna.bg 8 Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium; greet.cardon@ugent.be (G.C.); Ilse.Debourdeaudhuij@UGent.be (I.D.B.) 9 Dr von Hauner Children’s Hospital, LMU-Ludwig-Maximilians-University at Munich, D-80337 Munich, Germany; Berthold.Koletzko@med.uni-muenchen.de 10 Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece; manios.toybox@hua.gr * Correspondence: l.gibson@roehampton.ac.uk † Membership of ToyBox-study group is provided in the Acknowledgments. Received: 29 December 2019; Accepted: 4 February 2020; Published: 7 February 2020 Abstract: This study investigated parental influences on preschool children’s healthy and unhealthy snacking in relation to child obesity in a large cross-sectional multinational sample. Parents and 3–5 year-old child dyads ( n = 5185) in a kindergarten-based study provided extensive sociodemographic, dietary practice and food intake data. Parental feeding practices that were derived from questionnaires were examined for associations with child healthy and unhealthy snacking in adjusted multilevel models, including child estimated energy expenditure, parental education, and nutritional knowledge. Parental healthy and unhealthy snacking was respectively associated with their children’s snacking (both p < 0.0001). Making healthy snacks available to their children was specifically associated with greater child healthy snack intake ( p < 0.0001). Conversely, practices that were related to unhealthy snacking, i.e., being permissive about unhealthy snacking and acceding to child demands for unhealthy snacks, were associated with greater consumption of unhealthy snacks by children, but also less intake of healthy snacks (all p < 0.0001). Parents having more education and greater nutritional knowledge of snack food recommendations had children who ate more healthy snacks (all p < 0.0001) and fewer unhealthy snacks ( p = 0.002, p < 0.0001, respectively). In the adjusted models, child obesity was not related to healthy or unhealthy snack intake in these young children. The findings support interventions that address parental practices and distinguish between healthy and unhealthy snacking to influence young children’s dietary patterns. Keywords: child obesity; snacking; preschool children; nutrition; parents; feeding practices; Europe Nutrients 2020 , 12 , 432; doi:10.3390 / nu12020432 www.mdpi.com / journal / nutrients 7 Nutrients 2020 , 12 , 432 1. Introduction Trends in childhood obesity are a concern in many countries, with evidence for increasing prevalence of obesity, even in preschool children [ 1 ]. Numerous interventions have been attempted, addressing eating, drinking, and activity energy-balance related behaviours, primarily in school-aged children, but with mixed success [ 2 – 4 ]. In younger children, family environment, and particularly parental feeding practices, are strong predictors of both children’s diet [ 5 ] and adiposity [ 6 ], and so successful interventions should include these aspects. Snacking is an important energy-balance related dietary behaviour in children: young children have proportionately the highest nutritional and energetic requirements of any stage of the lifespan [ 7 ]; thus, frequent eating, including snacking between meals, is typical, easily reinforced, and avoids acute nutritional deficits that might otherwise limit physical and psychological development [ 8 , 9 ]. Therefore, snacking can substantially contribute to daily energy intake; for example, one recent comparison of four national nutritional surveys of 4–13-year-old children found that snacking provided up to one-third of energy intake [ 10 ]. Furthermore, there is concern that children’s choice of snacks are often particularly high in sugar and fat [ 11 , 12 ]. Therefore, it is important to distinguish between snacking on foods with a healthy nutrient profile (e.g., fruit and vegetables, unsweetened dairy) from those with unhealthy profiles (e.g., those high in fat, sugar, and / or salt, but low in essential nutrients), and to understand their determinants [8]. The strong influence of parental eating behaviour and feeding practices on children’s diet is well established [ 6 , 13 ]. However, there is less understanding of parental influences, specifically on children’s snacking behaviours [ 14 , 15 ], i.e., energy consumption between meals, particularly in relation to how di ff erent healthy or unhealthy snacking habits, might contribute to children’s risk of obesity [ 16 ]. A recent systematic review of 47 studies on parenting practices that included information on children’s snacking found that 39 of these studies concerned parenting practices not specifically related to snacking [ 17 ]. Furthermore, the most consistent significant associations were that parental restriction of food was related to higher levels of child snacking, which suggests reactive rather than proactive parenting [ 17 ]. This reactive parenting appears to be a common response [ 18 ], with such parental food restriction also being positively associated with child obesity [ 19 ]. By contrast, there is a paucity of evidence for beneficial e ff ects of proactive parenting, such as modelling, on children’s snacking per se , although the shared family environment is known to explain most of the varian