Skip to main content
Advertisement
Browse Subject Areas
?

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here.

  • Loading metrics

Family meal frequency and its association with food consumption and nutritional status in adolescents: A systematic review

  • Giselle Rhaisa do Amaral e Melo ,

    Contributed equally to this work with: Giselle Rhaisa do Amaral e Melo, Priscila Olin Silva, Jennifer Nakabayashi

    Roles Conceptualization, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – original draft, Writing – review & editing

    giselle-melo1502@hotmail.com

    Affiliation Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil

  • Priscila Olin Silva ,

    Contributed equally to this work with: Giselle Rhaisa do Amaral e Melo, Priscila Olin Silva, Jennifer Nakabayashi

    Roles Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

    Affiliation Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil

  • Jennifer Nakabayashi ,

    Contributed equally to this work with: Giselle Rhaisa do Amaral e Melo, Priscila Olin Silva, Jennifer Nakabayashi

    Roles Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing

    Affiliation Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil

  • Mariane Viana Bandeira ,

    Roles Conceptualization, Writing – review & editing

    ‡ MVB, NT and RM also contributed equally to this work.

    Affiliation Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil

  • Natacha Toral ,

    Roles Conceptualization, Project administration, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing

    ‡ MVB, NT and RM also contributed equally to this work.

    Affiliation Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil

  • Renata Monteiro

    Roles Conceptualization, Writing – review & editing

    ‡ MVB, NT and RM also contributed equally to this work.

    Affiliation Department of Nutrition, University of Brasilia, Brasilia, Distrito Federal, Brazil

Abstract

This systematic review evaluated the association between frequency of family meals (FFM) and nutritional status (NS) and/or food consumption (FC) in adolescents. The protocol was registered with PROSPERO (CRD42017062180) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. No publication date, language, or meal type restrictions were imposed. Only full-text original articles were included; qualitative studies were excluded. Studies were identified by searching 5 electronic databases (PubMed, Web of Science, Scopus, BVS Brazil, and Adolec) and gray literature (Google Scholar) and by scanning reference lists of included articles. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort and cross-sectional studies. Initial search yielded 2001 results and 47 articles were included. An updated literature search added 3 articles. Of the 50 studies included, 25 studied the association between FFM and NS, 32 investigated the association between FFM and FC, being that seven studies analyzed both outcomes. Thirty-four were cross-sectional studies, 12 were longitudinal studies, and 4 studies analyzed both cross-sectional and longitudinal data. Thirty-five studies were rated as having good quality, whereas 19 were of fair quality. Sample size ranged from 140 to 102 072 participants. Most investigations evaluated the frequency of breakfast, lunch, and/or dinner/supper/evening meals over a 1-week period. Seventeen studies identified a positive relationship between high FFM and better NS, and 26 found a positive association between high FFM and better FC. In conclusion, this review showed an association between FFM and healthy dietary patterns, such as increased consumption of fruits and vegetables. Further research is needed to understand the association between FFM and NS, since some studies showed a protective role of family meals against obesity in this age group, whereas other studies identified no significant association between these variables.

Introduction

Eating habits that tend to involve large amounts of ultra-processed foods, especially those developed in adolescence, are among the main causes of obesity, which is considered a global public health problem [13]. Obesity is a condition that affects nearly 124 million children and adolescents worldwide [4]. Targeted interventions are therefore required to promote dietary and nutrition education in these populations. National dietary recommendations, such as the Dietary Guidelines for Brazilians 2014 [5], have emphasized the importance of monitoring the content of meals, as well as how and when they take place. Meals should be regular and not hurried, and consumed in appropriate locations, in a calm and comfortable environment, and, whenever possible, together with family, friends, or colleagues [5].

Family meals appear to provide several benefits to adolescents, such as the promotion of healthy eating habits [69] and a lower risk of overweight [610]. Neumark-Sztainer et al. (2010) found a positive impact on food consumption (FC) among youths who had regular family meals (3 or more meals per week), including lower intake of soft drinks and higher intakes of fruits, vegetables, and calcium-rich foods [10]. In another study, Neumark-Sztainer et al. showed that adolescents reporting 7 or more family meals per week had lower intake of snack foods than those reporting fewer family meals [11]. Previous studies have found a significant association between frequency of family meals (FFM) and weigh status, with greater risk of overweight in white youths reporting never eating family meals than in those reporting 3 or more family meals per week, as well as an association of FFM with higher fat mass and body mass index (BMI) z-scores in 17-year-old South African adolescents reporting none or 1 family meal per week [6, 12].

Despite the growing interest in this topic, there is still a dearth of evidence on the effects of regular family meals on FC and nutritional status (NS) in adolescents. Fulkerson et al. (2014) conducted a review to investigate the impact of FFM on dietary and weight outcomes across the lifespan, but only 10 of the selected studies focused on adolescents [7]. Others have also investigated the association between FFM and nutritional outcomes in adolescents, but the reviews had some limitations: one did not consider NS and was limited to articles published in English in 2009 or earlier from only 2 databases [8], and the other also searched only 2 databases, had language restrictions, and included only papers whose main objective was to investigate the relationship between FFM and nutritional outcomes [9]. These observations indicated the need for a systematic review of the evidence for FFM and its association with FC and NS in adolescents.

Materials and methods

This was a systematic review of studies investigating the association of FFM with NS and/or FC in adolescents aged 10 to 19 years, as defined by the World Health Organization [13]. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [14], and its protocol was registered with PROSPERO (CRD42017062180; available at https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=62180).

Data sources, search strategy, and inclusion criteria

No type of meal, publication date, or language restrictions were imposed. Only full-text original articles were included in this review. Quantitative studies of any design were eligible, but qualitative studies were excluded. For the purposes of this review, NS refers to anthropometric measurements and FC refers solely to the intake of food/nutrients and the quality of the diet; thus, studies that associated other aspects of eating behaviors with FFM were not considered. Studies were considered eligible regardless of whether data on FFM was self-reported by the adolescents or reported by parents/legal guardians. Studies were not required to cite the association between these variables as a main objective to be included in the review. Studies involving older children or young adults in addition to adolescents were also considered eligible for inclusion. Investigations of clinical populations or individuals with eating disorders, studies where exposure or outcomes did not occur during adolescence, and studies in which the outcome was not the frequency but rather the quality of family meals were excluded from this review.

Studies were identified by searching 5 electronic databases (PubMed, Web of Science, Scopus, BVS Brazil, and Adolec) and gray literature (Google Scholar) and by scanning reference lists of included studies. Google Scholar searches were by relevance and limited to the first 200 citations. Three sets of MeSH terms were used to account for FFM, NS, and FC and needed to be displayed in the title or abstract. The search strategy was initially developed for PubMed (Fig 1) and later adapted for use in all other databases. No filters were applied to any database in the initial search, which was run in August 2019. An updated literature search was performed in May 2020 in all databases using the same search strategy, but with a filter for year of publication (2019–2020).

Study selection process

Two independent reviewers (R1 and R2) screened titles and abstracts identified by the initial search. Disagreements between the 2 reviewers were resolved by consulting a third reviewer (R3) for arbitration. Duplicates were removed, and the remaining studies were organized using Mendeley Ltd. Full text was obtained for all studies meeting the inclusion criteria and were read independently by 2 reviewers (R1 and R2). Disagreements were resolved by discussion and consensus among R1, R2, and R3, or by consulting an expert (R5). The reference lists of all studies selected for full-text review were hand-searched by R3, and decisions to include additional studies were made in a meeting involving all the aforementioned reviewers. In the update, the titles and abstracts of the articles retrieved were screened by 3 reviewers (R1, R2 and R3) simultaneously, and disagreements were resolved in a discussion meeting. Subsequently, all studies meeting the inclusion criteria were independently read in full by the 3 reviewers (R1, R2 and R3). There were no disagreements at this stage.

Extraction, risk of bias, and data analysis

The following data were extracted from each study and included in a table designed specifically for this review by 2 of the reviewers (R2 and R3): study characteristics (year of publication, funding sources, and country of origin); sample characteristics (age, recruitment process, and ethnicity); family meal characteristics (type of meal evaluated and FFM); and outcome characteristics (main results, variables measured, and type of assessment). A third reviewer (R1) checked the data for consistency and accuracy.

Risk of bias was assessed by one reviewer (R1), while a second reviewer (R2) reviewed the ratings for consistency and accuracy. Studies were evaluated using the Newcastle-Ottawa scale (NOS) for cohort and cross-sectional studies. The NOS is increasingly used as a measure to assess the quality of nonrandomized trials and provides a separate version for each of these study designs [15, 16]. Published thresholds were used to convert NOS scores into Agency for Healthcare Research and Quality (AHRQ) standards (good, fair, and poor). Because item 4 in the selection domain of the NOS for cohort studies was rated as ‘not applicable’ for all included articles, those with at least 4 stars in other domains were considered of good quality. Investigations with both longitudinal and cross-sectional components were analyzed twice, once for each study design.

Data were compiled into 2 summary tables (NS and FC). A meta-analysis was not possible due to the methodological heterogeneity caused by variations in exposure and outcome measurements across studies, in addition to the absence of confidence intervals and odds ratios in studies that did not investigate the association between FFM and FC or NS as the main objective. A narrative synthesis of extracted findings was conducted by grouping secondary variables into the following 5 categories: dietary habits, lifestyle and social factors, psychological factors, family meal environment, and adolescent health. These findings were discussed by focusing on the association of these variables with FFM, rather than on FFM itself.

Results

Search results, design & quality assessment

The initial search yielded 2001 results, of which 47 were included. The search update yielded 329 results, of which 3 were eligible for inclusion, for a total of 50 articles included in this review. The study selection process, including the initial search and the update, is shown in Fig 2. Twenty-five studies investigated the association between FFM and NS [12, 1740] and are summarized in Table 1. The association between FFM and FC was investigated in 32 studies, which are summarized in Table 2 [11, 17, 22, 23, 27, 30, 38, 39, 4164]. Seven studies [17, 22, 23, 27, 30, 38, 39] focused on both NS and FC and were included in both tables. Thirty-four were cross-sectional studies [11, 17, 18, 21, 22, 25, 27, 29, 3135, 3741, 4346, 48, 50, 51, 53, 5562], 12 were longitudinal [19, 20, 24, 26, 28, 29, 31, 42, 47, 49, 63, 64], and 4 studies analyzed both cross-sectional and longitudinal data [12, 36, 52, 54].

thumbnail
Table 1. Description of studies investigating the association between family meal frequency and adolescent nutritional status.

https://doi.org/10.1371/journal.pone.0239274.t001

thumbnail
Table 2. Description of studies investigating the association between family meal frequency and adolescent food consumption.

https://doi.org/10.1371/journal.pone.0239274.t002

The cross-sectional and longitudinal components of studies with both types of data were evaluated separately for risk of bias. According to the NOS, 35 studies were rated as having good quality (27 cross-sectional and 8 longitudinal) [12, 1726, 3238, 4245, 47, 48, 5052, 54, 56, 5861, 63, 64], whereas 19 were of fair quality (15 cross-sectional and 4 longitudinal) [11, 20, 2731, 36, 3941, 46, 49, 5255, 57, 62]. In most cases, cross-sectional studies were rated as having fair quality because of lack of justification of sample size, no calculation of the response rate, or no description of characteristics of responders and non-responders, and longitudinal studies because of written self-report questionnaires to investigate exposure, follow-up rate <80%, or no description of participants lost to follow-up.

Overview of included studies

The studies included in this review were published between 2000 and 2020, with 23 published in the past 5 years [17, 22, 2529, 33, 37, 41, 43, 44, 48, 49, 51, 53, 5561]; of these, 8 were published between 2019 and 2020 [17, 20, 22, 26, 41, 43, 51, 58]. Thirty-one studies were conducted in North America [11, 12, 19, 20, 23, 24, 2732, 34, 35, 36, 4147, 49, 52, 53, 55, 56, 6164], and 27 of these were conducted in the United States. An additional 6 studies were performed in Europe [21, 22, 38, 41, 50, 60], 4 in Oceania [18, 39, 40, 54], and 4 in Latin America [26, 48, 58, 59]. Three studies were performed in Asia [25, 51, 57], 1 in Africa [33], and 1 in the Middle East [17].

Population.

Sample sized ranged from 140 [29] to 102 072 [58] participants, with 32 studies assessing over 1000 individuals [11, 12, 1822, 24, 25, 3040, 44, 45, 47, 51, 52, 55, 5863]. Except for 1 study that evaluated only females [17], all others included both males and females. Thirteen studies provided no information on participant ethnicity [21, 22, 25, 26, 40, 4951, 54, 59, 60, 62, 63]. The other studies described ethnicity and/or race in different ways, but in most of them (n = 24) samples were predominantly Caucasian or non-Hispanic white [11, 12, 1820, 2729, 32, 3436, 41, 4447, 49, 52, 53, 55, 56, 61, 64].

Assessment of FFM.

Each study assessed the frequency of at least one main meal (breakfast, lunch, dinner/supper/evening meal). Of 50 studies, 17 assessed the frequency of meals in general [11, 12, 18, 2124, 32, 35, 39, 42, 45, 46, 48, 49, 53, 57], 11 assessed dinner, supper, or evening meals [20, 25, 36, 38, 47, 55, 56, 6164], 8 assessed dinner only [2729, 34, 41, 43, 50, 54], 5 assessed all 3 main meals (breakfast, lunch, and dinner) [17, 33, 37, 40, 44], 4 assessed only breakfast [26, 31, 51, 52], 3 assessed breakfast and dinner or evening meals [19, 30, 60], and 2 assessed lunch and dinner [58, 59].

Most studies (n = 40) analyzed FFM over a 1-week period [11, 12, 1825, 27, 28, 3035, 37, 39, 41, 42, 4446, 4850, 5264]. However, 5 studies did not provide a specific time frame [20, 26, 29, 36, 43], while 2 studies assessed meals in the last 5 weekdays [38, 40], 1 in the last 3 days [17], 1 in a single day [47], and 1 focused on usual meals during the past year [51].

FFM was self-reported by the adolescents in 34 studies [11, 12, 17, 20, 21, 2326, 29, 30, 3336, 38, 39, 42, 44, 45, 47, 49, 5153, 5560, 6264] and reported by parents in 8 studies [22, 32, 37, 40, 41, 43, 46, 54]. In 7 studies, these data were reported by both parents and adolescents [18, 19, 27, 28, 31, 48, 50]. One study did not describe how these data were collected [61].

Most studies (n = 25) investigated FFM using multiple-choice questions, with responses limited to the time period under consideration (e.g., never, 1–3 times/week, 4–6 times/week, every day) or overall frequency (e.g., regularly/sometimes/never) [11, 12, 17, 18, 2024, 26, 30, 33, 34, 36, 3840, 47, 48, 52, 53, 57, 59, 6264]. Seven studies calculated the mean number of family meals in the period investigated [19, 27, 28, 35, 42, 55, 56], and 9 studies analyzed this variable divided into 2 categories (e.g., less than 5 or at least 5 meals a week; regularly or irregularly) [29, 32, 43, 46, 50, 51, 58, 60, 61]. Three studies also described the percentage of participants reporting different FFMs in the period under consideration (e.g., 3 or more family meals in the previous week; 5 to 7 meals in the previous week) [37, 44, 45]. Five studies did not provide descriptive data on FFM [25, 31, 41, 49, 54], and 1 study reported FFM as the number of meals in a day [17].

Other outcome variables.

In addition to FC and/or NS, 30 studies also evaluated lifestyle and social factors [1821, 24, 26, 29, 3032, 3541, 4345, 5053, 55, 56, 5962], such as physical activity, screen time, family structure, peer characteristics, household food insecurity, and availability of specific foods in the home. Twenty-seven studies also investigated dietary practices [21, 23, 24, 26, 33, 36, 3842, 4449, 5154, 5658, 6264], such as dieting, purchasing breakfast, snacking patterns, and eating behaviors. Twelve studies also evaluated family meal environment [21, 23, 24, 27, 28, 41, 43, 48, 51, 53, 54, 56], including variables such as mealtime conversation, family dinnertime routine, importance of mealtime, watching television during meals, parenting style, and parent dinnertime media use. Five studies assessed psychological factors [18, 20, 25, 48, 50], such as behavior problems and mental health. Five studies evaluated adolescent health factors [17, 20, 23, 32, 36], such as Tanner stages, physical health, health condition, and beginning of menstrual life for girls.

Main outcomes of FFM & NS

Ten studies investigated the association between FFM and BMI classifications. Of these, 6 identified a positive relationship between FFM and better NS. Alamri (2020) examined the influence of family meal type (breakfast, lunch, and dinner) on food intake and BMI of Saudi adolescent girls and found that eating a family lunch or dinner was negatively associated with adolescent BMI; however, no significant association was found between family breakfast and adolescent BMI [17]. Chang & Halgunseth (2014) examined the influence of acculturation, ethnicity, interactions among family meals, parental control, and FFM on changes in NS in Hispanic and Caucasian adolescents in the United States over approximately 4 years. The results showed that non-Hispanic white adolescents were more likely to maintain a healthy weight, not to purchase school lunch, and to eat more family meals. There was also an association between high FFM and a negative change in NS (normal to overweight) in Hispanic adolescents with lower parental behavioral control (high behavioral control and use of power assertive parenting techniques to address child misbehavior are part of the demandingness dimension of parenting style framework) [19]. Farajian et al. (2014) identified FFM as 1 of the 5 main predictors of overweight in childhood, as having frequent family meals was associated with a reduced risk of overweight and obesity [21]. Larson et al. (2013) found that a higher frequency of family breakfasts was associated with a lower risk of overweight [30]. Kubik et al. (2009) showed that obese students were more likely than their normal-weight peers to report no family meals in the previous week [29]. Sen (2006) assessed FFM and NS in individuals of different ethnicities and found that, for white adolescents, high FFM was associated with reduced weight in 1997 and with a reduced likelihood of becoming overweight and increased odds of ceasing to be overweight in 2000 [34]. Vik et al. (2016) evaluated the association between eating the 3 main meals with family members and NS in adolescents and showed that having regular family breakfast, but not lunch or dinner, was inversely associated with overweight [37]. The other 3 studies investigating these variables did not identify any significant association between them [20, 32, 40].

Eight studies evaluated the association between FFM and NS as defined by BMI. Six of these studies identified a negative association between exposure and outcome. Fulkerson et al. (2008) evaluated NS and FFM in adolescents over the course of 5 years and reported that, although these variables were not longitudinally associated, significant inverse relationships occurred between FFM and overweight in female adolescents in all cross-sectional models [12]. Goldfield et al. (2019) found that higher FFM was associated with lower BMI only in female participants [24]. Haghighatdoost et al. (2017) observed that family dinner frequency was inversely related to obesity in adolescents [25]. Hassan et al. (2019), in a 3-year longitudinal study, showed that male participants who did not have breakfast with their families had the largest increases in BMI over the course of the study, while the largest reductions in percent body fat were observed in male adolescents who reported an intermediate frequency of family breakfasts [26]. Taveras et al. (2005), in cross-sectional analyses, identified a lower likelihood of becoming overweight in participants who ate family dinner on “most days” or “every day” than in those who ate family dinner “some days or never”; no significant associations were observed in longitudinal analyses [36]. In the studies conducted by Babajafari et al. (2011) [18], Utter et al. (2008) [38], and Utter et al. (2013) [39], no significant associations were observed between FFM and NS in adolescents.

Seven studies also evaluated the association between FFM and NS using BMI z-scores or age-specific percentiles, and all of them identified positive associations between FFM and lower odds or prevalence of overweight. Frank et al. (2019), aiming to show current family meal patterns of children and adolescents aged 6 to 17 years living in Germany and to investigate associations with sociodemographic characteristics, BMI, and dietary behavior, found that overweight participants aged 12–17 years ate breakfast, afternoon snacks, or dinner together with their families less frequently than their non-overweight peers [22]. Fulkerson et al. (2009) reported that adolescents who did not eat dinner with their families in the week before the study were almost 3 times more likely to be overweight [23]. Horning et al. (2016), evaluating different measures of FFM, as reported by parents and adolescents, and the relationship between these variables and BMI z-scores, found, in adjusted analyses, that measures of sitting and eating together were inversely related to BMI z-scores in adolescents [27] In another study, Horning et al. (2017) evaluated the moderating role of FFM in the relationship between meal context and NS of parents and adolescents, and the results suggested that FFM amplifies the relationship between healthy eating behavior and BMI in the context of family meals [28]. Larson et al. (2013) showed that infrequent family meals were consistently associated with higher BMI z-scores in both boys and girls [31]. Sedibe et al. (2018), in cross-sectional analyses, showed that eating the main meal with the family on “some days” or “nearly every day” was 1 of the 2 main variables responsible for an increased risk of overweight and obesity only in black or rural preadolescents [33]. The only study to use BMI percentiles was conducted by Smith Price et al. (2009), who found that more frequent family meals led to improvements in NS over time [35].

Main outcomes of FFM & FC

Most studies (n = 24) used food-frequency questionnaires that had been previously validated or developed specifically for the study [11, 22, 23, 30, 38, 39, 4252, 54, 55, 5761]. The remaining studies used 24-h dietary records [17, 27, 41, 53, 56, 6264].

Using a food-frequency questionnaire, Fulkerson et al. (2009) analyzed breakfast content, dietary habits, fruit and vegetable consumption, and unhealthy food intake and found that family dinner frequency was positively associated with breakfast frequency and daily fruit intake, but not with fast-food restaurant use, regular soft drink consumption, vegetable consumption, combined fruit and vegetable consumption, or high-fat food intake [23]. Frank et al. (2019), in a subsample from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS/2014-2017), investigated an association between FFM and food intake or the frequency of consumption of food groups and found that the daily consumption of sugary drinks is lower in adolescents aged 12–17 years who have breakfast with their families every day/often than in those who rarely/never have breakfast with the family. Analyses for other food groups, including fruit, vegetables, water, confectionery/salty snacks, milk products, meat/sausages, cereal products, fast food, and fish, showed no significant associations [22]. Larson et al. (2013) evaluated the association between frequency of family breakfasts and food intake and found that adolescents who ate more meals with their families were more likely to have positive dietary habits, including increased consumption of fruit, whole grains, fiber, and potassium, as well as reduced consumption of sugar-sweetened beverages [30]. In the studies conducted by Utter et al. (2008) and Utter et al. (2013), a positive association was identified between higher fruit and vegetable intake and frequency of family breakfast [38, 39].

Burgess-Champoux et al. (2009) examined the longitudinal association between participation in family meals and dietary habits in adolescence over a 5-year period. Male and female adolescents who ate regular family meals (at least 5 per week) had higher intakes of vegetables, calcium-rich foods, fiber, and several vitamins and minerals [42]. Conlon et al. (2019) assessed the influence of family environment on obesity-related health behaviors in adolescents and showed that participants with higher FFM were more likely to eat fruits, but they did not differ from their peers in the consumption of vegetables or sugar-sweetened beverages. Additionally, adolescents whose parents reported a higher frequency of television watching during family meals were likely to eat less fruit [43]. Demissie et al. (2015) classified participants’ dietary habits as healthy or unhealthy based on the intake of different food groups and found that healthier eating habits were associated with higher FFM [44].

Feldman et al. (2007) reported that adolescents who watched television during family meals were more likely to have a poorer diet than those who did not. Television watching during family meals was associated with lower intakes of vegetables, grains, and dairy products and with higher intakes of soft drinks and fried foods. Additionally, the results showed that adolescents eating regular family meals while watching television had better dietary intake than those not eating regular family meals [45]. Fink et al. (2014) also found that having 5 or more family meals per week was associated with higher intakes of vegetables and fruit in participants aged 12–17 years [46]. Gillman et al. (2000) reported that a higher frequency of family dinners was associated with healthier eating habits, including higher intakes of fruit, vegetables, fiber, and micronutrients and lower intakes of fried foods, soft drinks, and saturated and trans fats. In addition, FFM was associated with lower glucose levels, although it was not significantly associated with the intake of red meat or snack foods [47]. Hong et al. (2019), using data from a national Korean survey to compare adolescents who had breakfast with their families with those who had this meal alone, performed analyses for the association between FFM and nutritional quality, food intake, meal frequency, and energy intake and found that the food intake of carbohydrates and iron, the average Dietary Diversity Score, and the number of servings of grains and vegetables were significantly higher in the family breakfast group. However, the consumption of milk and dairy products was higher in the group of participants eating breakfast alone [51].

Giray & Ferguson (2018), examining the association between the frequency and quality of family meals and nutritional outcomes in young Jamaicans, found no significant associations between these variables [48]. Granner & Evans (2011), evaluating individual characteristics, social factors, family environment and their relationship to fruit and vegetable intake in adolescents, showed, in multivariate analyses, a positive association between the frequency of family dinners and daily fruit and vegetable intake, as evidenced by differences between adolescents who ate fewer than 3 portions and those who ate 3–4 portions of fruit and vegetables per day, and between those who ate fewer than 3 portions and those who ate more than 5 portions per day [49]. Haapalahti el at. (2003) found a significant association between FFM and healthier eating habits, such as lower intakes of fast foods and sweets by adolescents [50]. Larson et al. (2007), investigating FFM in adolescence and its relationship to food intake in young adulthood, showed a significant association of FFM with a higher quality diet, higher intakes of fruit, vegetables, and micronutrients, and lower intake of soft drinks [52]. Alamri (2020), examining the influence of the type of family meal (breakfast, lunch, and dinner) on the food intake of female adolescents, found that family breakfast was positively associated with the consumption of dairy products and proteins, family lunch was positively associated with eating vegetables and proteins, and family dinner was positively associated with the intake of fruit, vegetables, dairy products, and whole grains [17].

Leech et al. (2014) reported that daily family dinners were associated with healthy food habits, including higher consumption of fresh and dried fruits, vegetables, low-fat milk, and water and lower intake of energy-dense foods (sweet and savory foods, high-energy beverages), but only in male adolescents [54]. Lipsky et al. (2015) examined tendencies and changes in eating behaviors during the transition between adolescence and early adulthood and found that the intake of fruits, vegetables, and whole grains in this age range was positively associated with FFM [55]. Makansi et al. (2018) also evaluated eating habits and factors associated with fruit and vegetable intake, but no significant relationships were identified between FFM and fruit or vegetable consumption [57]. Martins et al. (2019) showed that eating at least 5 family meals per week was positively associated with the intake of beans, fruits, and vegetables (healthy diet score) and negatively associated with the consumption of sweets, ultra-processed salty foods, and fried salty snacks (unhealthy diet score) [58].

Neumark-Sztainer et al. (2003) assessed the patterns of family meals and their relationship to food and nutrient intake in a population of adolescents in the United States and found that adolescents with more frequent family meals had higher intakes of fruits, vegetables, grains, and calcium-rich foods. FFM was also negatively associated with the intake of soft drinks and snack foods [11]. Oliveira et al. (2018) reported that participants who ate more meals at home with their parents had a healthier diet and higher intakes of beans, vegetables, and milk, in addition to consuming smaller amounts of fried foods, sweets, and soft drinks on weekdays [59]. Totland et al. (2017) reported that lower frequency of family dinners was associated with lower vegetable intake among adolescents [60]. Walton et al. (2018) found that frequent family dinners were associated with healthier dietary habits, including higher fruit and vegetable intake and lower consumption of fast food and takeout in both boys and girls, as well as lower intake of sugar-sweetened beverages in boys [61].

Horning et al. (2016) identified a significant association of the frequency of family dinners with dietary quality and fruit and vegetable intake, as assessed by the Healthy Eating Index (HEI) [27]. Dietary quality and the intake of fruits and vegetables at dinner were also assessed by Arcan et al. (2019), who found that individuals with higher FFM were more likely to fill half their plate with fruits and vegetables, although they did not differ from their peers in terms of dietary quality [41]. Larson et al. (2016), investigating family meal experiences and fast-food purchasing among adolescents, evaluated several indicators of diet quality, but the only significant associations were found between the frequency of family breakfast and fruit intake in males, and refined grain intake in females [53]. Lipsky et al. (2017) showed that higher FFM was associated with higher scores on 3 diet quality indicators (HEI, Whole Plant Foods Density, and Empty Calories) [56]. Woodruff et al. (2009) showed that a higher frequency of family dinners was significantly associated with lower soft drink consumption and breakfast on the day of the study among adolescents [62]. Woodruff et al. (2010), investigating the association between FFM and overall diet quality, reported that adolescents who had 6 to 7 family meals per week had higher HEI scores than their peers [63]. Lastly, in another study, Woodruff et al. (2014) examined the association between family dinner frequency and number of meals and snacks per day and found that adolescents who had regular dinner with their families were likely to eat more meals and snacks on a daily basis as well as to consume fewer calories per day than those eating dinner with friends or alone [64].

Discussion

FFM has been extensively explored in the literature. However, previous systematic reviews have addressed only some aspects of this topic, and the present study makes several novel contributions to the existing body of knowledge. We provide an update of previous reviews that is especially relevant given the large number of studies published between 2019 and 2020, as was the case of 8 articles included in the present review [17, 20, 22, 26, 41, 43, 51, 58]. This topic has been more extensively investigated in infants and toddlers due to the regularity of family meals in these age groups [65], but studies in older children are beginning to emerge as a result of the adoption of a holistic approach to determinants of health behaviors, in addition to the increased prevalence of noncommunicable diseases and overweight in this population [66]. The studies included in this review showed significant variations in the definition of regular and irregular family meal patterns, the type of meal evaluated, the time frame studied, and the response options available to participants. Additionally, most of the selected studies were conducted in the United States, and since some aspects of family meals differ among cultures [67] their findings may not apply to other populations. Nevertheless, all continents were represented in this review.

Despite the heterogeneity of findings across studies, the literature reviewed in the present study had several positive attributes, such as the absence of poor-quality studies, a high number of investigations involving large samples, including 33 studies of more than 1000 participants [11, 12, 1822, 24, 25, 30, 32, 3340, 44, 45, 47, 51, 52, 55, 5863], the inclusion of boys and girls in almost all investigations, and the use of both cross-sectional and longitudinal designs in some studies. Several studies also investigated complementary variables and showed that family meals are influenced by other behavioral, psychological, and quality-of-life variables, such as household food security, physical activity levels of adolescents, and parental styles. These mediating factors should be explored in future studies, which will allow the measurement of their individual contribution to the phenomenon under study.

Of 25 studies evaluating the association between FFM and NS, 17 demonstrated an association between frequent family meals and lower incidence and prevalence of overweight in adolescents, suggesting that family meals may be protective against obesity in this population [12, 17, 2131, 3437]. However, some studies were sex-specific or ethnicity-specific, and these findings should also be explored in future reviews. Six studies did not find any significant association between the aforementioned variables [1820, 32, 3840], and only 2 of these studies [38, 39] also investigated dietary intake. A healthy diet is a main determinant of NS. Although family meals make a positive contribution to health by promoting commensality, slow chewing, bonding among family members, emotional and mental health, and even academic success by encouraging communication, their protective role against weight gain is heavily influenced by family eating habits; however, none of the included studies controlled for the influence of eating habits on the relationship between FFM and NS [6, 68]. Additionally, according to McCullough et al. (2016), the benefits of family meals are strongly influenced by the frequency, duration, and location of the meals, as well as by the type and amount of food offered, family communication, child or adolescent behavior, and the family members who are present, which underscores the importance of exploring additional variables pertaining to the family meal environment [69]. Moreover, the type of meal consumed with family (breakfast, lunch, and dinner or evening meals) might impact the FC of adolescents, since common foods consumed in each meal vary according to local culture. Alamri (2020) reported that different meals consumed with family were positively associated with the intake of different food groups [17]. In Brazil, for example, breakfast is usually associated with higher intakes of fruit and calcium, which can be explained by the traditional foods consumed in this meal [70]. Therefore, the relationship between the type of meal and FC warrants further investigation, including factors related to food culture.

Two studies revealed a significant association between FFM and weight gain in adolescents. One study [19] observed this association in Hispanic adolescents who were less acculturated and experienced lower parental control, suggesting that the influence of family meals on NS in adolescents also depends on factors such as parenting styles and the relationship between individuals and their home environment. This is in line with previous studies showing that having parents or guardians with low levels of behavioral control and high levels of authoritative parenting increases the risk of obesity in individuals from ethnic minorities, such as Hispanic children and adolescents living in the United States [71, 72]. The other study [33] showed an association of regular family meals with greater likelihood of overweight only in older children (6–11 years of age), highlighting the importance of further investigating this topic in future studies and addressing the issue of physical maturation in addition to the quality of the family diet.

An aspect that was not explored by the studies included in this review was the location of family meals. Eating meals outside the home or in fast-food restaurants, for instance, could contribute to weight gain and influence NS in adolescents. Therefore, in addition to FFM, it is important to investigate the quality and location of shared meals [7].

Studies investigating FC evaluated several healthy and unhealthy dietary practices and found that participants with higher FFM consumed more fruits, vegetables, whole grains, beans, and dairy products. In some studies, these individuals also showed a reduction in unhealthy dietary behaviors, such as the consumption of soft drinks, fried foods, and fast food. These findings are consistent with those of Hammons et al. (2011), who performed a meta-analysis of the frequency of shared meals and nutritional health in children and adolescents and included dietary intake as an outcome measure. The analysis showed that participants who shared meals with their families at least 3 times a week had healthier dietary habits and were 24% more likely to have healthier eating habits (OR = 1.24 CI: 1.13–1.37, p<0.01), such as higher fruit and vegetable intake and eating breakfast [73].

One study found a negative association between FFM and diet in adolescents [51], whereas 3 studies found no significant association between these variables [22, 48, 57]. Hong et al. (2019) reported that adolescents eating breakfast without their family consumed more milk and dairy products. Although this result appears negative, it can be explained by the typical South Korean breakfast, in which the foods typically consumed for breakfast are rice, kimchi, fish, and soup, among others, while the unhealthy breakfast pattern is usually milk, cereal, and industrialized versions of dairy products [51]. Assessment of dietary intake is complex, and clear operational definitions are required to ensure that the effects of exposure on this outcome are measured as accurately as possible. Other variables could also interfere with the association between FFM and dietary intake, such as family environment, eating environment, psychological factors, and watching television during meals. These elements should be considered in order to construct more reliable explanatory models and achieve a better comprehension of these phenomena. These factors may also be one of the reasons why the studies found no significant associations.

Four studies [27, 41, 56, 63] investigated dietary quality using original or adapted versions of the HEI and found healthy diet scores to be positively associated with FFM. This index was developed to assess overall diet quality, an approach that has been increasingly preferred over the assessment of individual attributes, such as the intake of specific food groups or nutrients [74]. It is interesting to note that some studies [46, 52, 55, 56] investigated associations between FFM in adolescence and eating habits in early adulthood, with significant findings for these variables. These results further support the role of family meals as a potentially positive influence on the adoption of healthier eating habits over the life course. One of these studies, conducted by Giray & Ferguson (2018), found that diet quality was not related to FFM but rather to the quality of the meal experience, revealing that other variables in addition to meal frequency can have a considerable influence on eating behaviors [48].

Although the literature points to a positive association of family meals with quality of diet and healthy NS, there is still no consensus on the ideal number of meals, type of meal, or other meal patterns that families should adopt to really make it a protective factor for nutritional health in adolescents. Some studies have already provided important clues about this positive association, such as the study by Tosatti et al. (2017) [9], who reinforced the need to expand investigations by using designs that allow establishing such parameters. It will be useful to advise and guide families on this subject and fill the gaps of previous research. It is also essential to consider the cultural peculiarities that influence FC and eating practices around the world.

Conclusions

This review showed an association between FFM and healthy dietary patterns, such as increased consumption of fruits, vegetables, whole grains, and beans. Further research is needed to understand the association between FFM and NS, since some studies showed a protective role of family meals against obesity in this age group, whereas other studies identified no significant association between these variables. Nevertheless, a healthy diet is a known determinant of NS, and most studies of the association between FFM and NS did not control for FC, which may have influenced their findings. Future research examining associations between FFM and FC and/or NS should consider other meal characteristics such as the duration and location of the meals, the type of meal, and the type and/or amount of food served.

References

  1. 1. De Moura Souza A, Barufaldi LA, De Azevedo Abreu G, Giannini DT, De Oliveira CL, Dos Santos MM, et al. ERICA: Intake of macro and micronutrients of Brazilian adolescents. Rev Saude Publica. 2016;50(suppl 1):1s–15s. pmid:26910551
  2. 2. Bentham J, Di Cesare M, Bilano V, Bixby H, Zhou B, Stevens GA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42. pmid:29029897
  3. 3. World Health Organization. Adolescents’ Dietary Habits Key Facts and Figures [Internet]. 2016. http://www.euro.who.int/__data/assets/pdf_file/0006/303477/HBSC-No.7_factsheet_Diet.pdf?ua=1
  4. 4. Abarca-GÃ L, Abdeen ZA, Abdul Hamid Z, Abu-Rmeileh NM, Acosta-Cazares B, Acuin C, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults NCD Risk Factor Collaboration (NCD-RisC)*. Lancet [Internet]. 2017 [cited 2020 May 7]; 390:2627–42. pmid:29029897
  5. 5. Ministério da Saúde. Guia Alimentar para a População Brasileira [Internet]. 2nd ed. Brasília: Ministério da Saúde; 2014 [cited 2020 May 7]. 156 p. www.saude.gov.br/bvs
  6. 6. Martin-Biggers J, Spaccarotella K, Berhaupt-Glickstein A, Hongu N, Worobey J, Byrd-Bredbenner C. Come and Get It! A Discussion of Family Mealtime Literature and Factors Affecting Obesity Risk1–3. Adv Nutr. 2014 May 1;5(3):235–47. pmid:24829470
  7. 7. Fulkerson JA, Larson N, Horning M, Neumark-Sztainer D. A review of associations between family or shared meal frequency and dietary and weight status outcomes across the lifespan. J Nutr Educ Behav. 2014 Jan;46(1):2–19. pmid:24054888
  8. 8. Woodruff SJ, Hanning RM. A Review of family meal influence on adolescents’ dietary intake. Vol. 69, Canadian Journal of Dietetic Practice and Research. 2008. p. 14–22. pmid:18334049
  9. 9. Tosatti AM, Ribeiro LW, Machado RHV, Maximino P, Bozzini AB, Ramos C de C, et al. Fazer refeições em família tem efeito protetor para a obesidade e bons hábitos alimentares na juventude? Revisão de 2000 a 2016. Vol. 17, Revista Brasileira de Saude Materno Infantil. Instituto Materno Infantil Professor Fernando Figueira; 2017. p. 425–34.
  10. 10. Neumark-Sztainer D, Larson NI, Fulkerson JA, Eisenberg ME, Story M. Family meals and adolescents: What have we learned from Project EAT (Eating Among Teens)? Public Health Nutr. 2010;13(7):1113–21. pmid:20144257
  11. 11. Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents. J Am Diet Assoc. 2003 Mar;103(3):317–22. pmid:12616252
  12. 12. Fulkerson JA, Neumark-Sztainer D, Hannan PJ, Story M. Family meal frequency and weight status among adolescents: cross-sectional and 5-year longitudinal associations. Obesity (Silver Spring). 2008 Nov;16(11):2529–34. pmid:18719674
  13. 13. World Health Organization. Adolescence: a period needing special attention. Recognizing adolescence [Internet]. 2014 [cited 2020 May 20]. https://apps.who.int/adolescent/second-decade/section2/page1/recognizing-adolescence.html
  14. 14. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev [Internet]. 2015 Jan 1 [cited 2020 May 7];4(1):148–60. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-4-1. pmid:25554246
  15. 15. Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, et al. Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis. Fuchs FD, editor. PLoS One [Internet]. 2016 Jan 25 [cited 2020 May 7];11(1):e0147601. Available from: https://dx.plos.org/10.1371/journal.pone.0147601 pmid:26808317
  16. 16. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. 2014 [cited 2020 May 7]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
  17. 17. Alamri E. Family meal associated with better dietary quality during adolescence. Med Sci [Internet]. 2020 [cited 2020 May 7];24(102):786–92. Available from: http://www.discoveryjournals.org/medicalscience/current_issue/v24/n102/A45.htm pmid:17761227
  18. 18. Babajafari S, Marks GC, Mamun AA, O’Callaghan MJ, Najman JM. Family Food Behaviours and Adolescents’ Overweight Status: A Mother-Offspring Link Study. Iran RED CRESCENT Med J. 2011 Nov;13(11):783–94. pmid:22737418
  19. 19. Chang Y, Halgunseth LC. The Association Between Family Meals and Early-Adolescents’ Weight Status Change in the Context of Parental Discipline Practices: The Moderating Roles of Ethnicity and Acculturation. J Immigr Minor Heal. 2015 Mar 22;17(2):450–8. pmid:25138136
  20. 20. Chen Y, Haines J, Charlton BM, VanderWeele TJ. Positive parenting improves multiple aspects of health and well-being in young adulthood. Vol. 3, Nature Human Behaviour. Nature Research; 2019. p. 684–91.
  21. 21. Farajian P, Panagiotakos DB, Risvas G, Malisova O, Zampelas A. Hierarchical analysis of dietary, lifestyle and family environment risk factors for childhood obesity: the GRECO study. Eur J Clin Nutr. 2014 Oct;68(10):1107–12. pmid:24824010
  22. 22. Frank M, Brettschneider A, Barbosa C, Haftenberger M, Lehmann F, Perlitz H, et al. Prevalence and temporal trends of shared family meals in Germany. Ernaehrungs Umschau [Internet]. 2019 Apr [cited 2020 May 7];60–7.
  23. 23. Fulkerson JA, Kubik MY, Story M, Lytle L, Arcan C. Are There Nutritional and Other Benefits Associated with Family Meals Among At-Risk Youth? J Adolesc Heal. 2009 Oct;45(4):389–95. pmid:19766944
  24. 24. Goldfield GS, Murray MA, Buchholz A, Henderson K, Obeid N, Kukaswadia A, et al. Family meals and body mass index among adolescents: effects of gender. Appl Physiol Nutr Metab [Internet]. 2011 Aug;36(4):539–46. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=21851205&lang=pt-br&site=ehost-live pmid:21851205
  25. 25. Haghighatdoost F, Kelishadi R, Qorbani M, Heshmat R, Motlagh ME, Ardalan G, et al. Family Dinner Frequency is Inversely Related to Mental Disorders and Obesity in Adolescents: the CASPIAN-III Study. Arch Iran Med. 2017 Apr;20(4):218–23. pmid:28412825
  26. 26. Hassan BK, Cunha DB, da Veiga GV, Pereira RA, Hoffman DJ, Sichieri R. Breakfast Consumption, Family Breakfast, and Adiposity Trajectory in Adolescence—The Adolescent Nutritional Assessment Longitudinal Cohort Study. J Acad Nutr Diet. 2019 Jun 1;119(6):944–56. pmid:30745069
  27. 27. Horning ML, Fulkerson JA, Friend SE, Neumark-Sztainer D. Associations among Nine Family Dinner Frequency Measures and Child Weight, Dietary, and Psychosocial Outcomes. J Acad Nutr Diet. 2016 Jun;116(6):991–9. pmid:26875023
  28. 28. Horning ML, Schow R, Friend SE, Loth K, Neumark-Sztainer D, Fulkerson JA. Family dinner frequency interacts with dinnertime context in associations with child and parent BMI outcomes. J Fam Psychol [Internet]. 2017 Oct [cited 2018 Jun 20];31(7):945–51. Available from: http://doi.apa.org/getdoi.cfm?doi=10.1037/fam0000330 pmid:28504521
  29. 29. Kubik MY, Davey C, Fulkerson JA, Sirard J, Story M, Arcan C, et al. Alternative high school students: prevalence and correlates of overweight. Am J Health Behav [Internet]. 2009 Sep;33(5):600. pmid:19296750
  30. 30. Larson NI, Wall MM, Story MT, Neumark-Sztainer DR. Home/family, peer, school, and neighborhood correlates of obesity in adolescents. Obesity (Silver Spring) [Internet]. 2013 Sep;21(9):1858–69. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=23512596&lang=pt-br&site=ehost-live pmid:23512596
  31. 31. Larson N, MacLehose R, Fulkerson JA, Berge JM, Story M, Neumark-Sztainer D. Eating breakfast and dinner together as a family: associations with sociodemographic characteristics and implications for diet quality and weight status. J Acad Nutr Diet. 2013 Dec;113(12):1601–9. pmid:24139290
  32. 32. Ness M, Barradas DT, Irving J, Manning SE. Correlates of overweight and obesity among American Indian/Alaska Native and Non-Hispanic White children and adolescents: National Survey of Children’s Health, 2007. Matern Child Health J. 2012;16 Suppl 2(02):268–77. pmid:23229132
  33. 33. Sedibe MH, Pisa PT, Feeley AB, Pedro TM, Kahn K, Norris SA. Dietary habits and eating practices and their association with overweight and obesity in rural and urban black South African adolescents. Nutrients. 2018 Feb 1;10(2). pmid:29382137
  34. 34. Sen B. Frequency of family dinner and adolescent body weight status: evidence from the national longitudinal survey of youth, 1997. Obesity (Silver Spring). 2006 Dec;14(12):2266–76.
  35. 35. Smith Price JL, Day RD, Yorgason JB, Price JLS, Day RD, Yorgason JB. A longitudinal examination of family processes, demographic variables, and adolescent weight. Marriage Fam Rev [Internet]. 2009 Feb;45(2/3):310–30. Available from: https://search.proquest.com/docview/199560177?accountid=26646
  36. 36. Taveras EM, Rifas-Shiman SL, Berkey CS, Rockett HRH, Field AE, Eindsay Frazier A, et al. Family dinner and adolescent overweight. Obes Res [Internet]. 2005;13(5):900–6. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-24344461853&partnerID=40&md5=b4eb44b404e38fee125acdd6582aaaf7 pmid:15919844
  37. 37. Vik FN, Te Velde SJ, Van Lippevelde W, Manios Y, Kovacs E, Jan N, et al. Regular family breakfast was associated with children’s overweight and parental education: Results from the ENERGY cross-sectional study. Prev Med (Baltim). 2016 Oct;91:197–203. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=19296750&lang=pt-br&site=ehost-live
  38. 38. Utter J, Scragg R, Schaaf D, Mhurchu CN. Relationships between frequency of family meals, BMI and nutritional aspects of the home food environment among New Zealand adolescents. Int J Behav Nutr Phys Act. 2008 Oct;5. pmid:18947431
  39. 39. Utter J, Denny S, Robinson E, Fleming T, Ameratunga S, Grant S. Family meals among New Zealand young people: relationships with eating behaviors and body mass index. J Nutr Educ Behav [Internet]. 2013 Jan;45(1):3–11. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=23110750&lang=pt-br&site=ehost-live pmid:23110750
  40. 40. Würbach A, Zellner K, Kromeyer-Hauschild K, Wurbach A, Zellner K, Kromeyer-Hauschild K, et al. Meal patterns among children and adolescents and their associations with weight status and parental characteristics. Public Health Nutr [Internet]. 2009 Aug;12(8):1115–21. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=19243677&lang=pt-br&site=ehost-live pmid:19243677
  41. 41. Arcan C, Friend S, Flattum CF, Story M, Fulkerson JA. Fill “half your child’s plate with fruits and vegetables”: Correlations with food-related practices and the home food environment. Appetite. 2019 Feb 1;133:77–82. pmid:30339784
  42. 42. Burgess-Champoux TL, Larson N, Neumark-Sztainer D, Hannan PJ, Story M. Are family meal patterns associated with overall diet quality during the transition from early to middle adolescence? J Nutr Educ Behav [Internet]. 2009 Mar;41(2):79–86. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=19304252&lang=pt-br&site=ehost-live pmid:19304252
  43. 43. Conlon BA, McGinn AP, Isasi CR, Mossavar-Rahmani Y, Lounsbury DW, Ginsberg MS, et al. Home environment factors and health behaviors of low-income, overweight, and obese youth. Am J Health Behav. 2019 Mar 1;43(2):420–36. pmid:30808480
  44. 44. Demissie Z, Eaton DK, Lowry R, Kim SA, Park S, Grimm KA, et al. The association of meal practices and other dietary correlates with dietary intake among high school students in the United States, 2010. Am J Heal Promot [Internet]. 2015;29(6):e203–13. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84937692010&doi=10.4278%2Fajhp.131211-QUAN-632&partnerID=40&md5=7fd617054497d30b3be717dbb7d68c4b
  45. 45. Feldman S, Eisenberg ME, Neumark-Sztainer D, Story M. Associations between watching TV during family meals and dietary intake among adolescents. J Nutr Educ Behav [Internet]. 2007 Sep;39(5):257–63. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-34548389373&doi=10.1016%2Fj.jneb.2007.04.181&partnerID=40&md5=42c56a412cb2adf390188fac1a2a3f1d pmid:17826345
  46. 46. Fink SK, Racine EF, Mueffelmann RE, Dean MN, Herman-Smith R. Family Meals and Diet Quality Among Children and Adolescents in North Carolina. J Nutr Educ Behav. 2014;46(5):418–22. pmid:24974356
  47. 47. Gillman MW, Rifas-Shiman SL, Frazier AL, Rockett HRH, Camargo CA, Field AE, et al. Family dinner and diet quality among older children and adolescents. Arch Fam Med. 2000 Mar;9(3):235–40. pmid:10728109
  48. 48. Giray C, Ferguson GM. Say yes to “Sunday Dinner” and no to “Nyam and Scram”: Family mealtimes, nutrition, and emotional health among adolescents and mothers in Jamaica. Appetite. 2018 Sep 1;128:129–37. pmid:29803778
  49. 49. Granner ML, Evans AE. Variables associated with fruit and vegetable intake in adolescents. Am J Health Behav [Internet]. 2011 Sep;35(5):591–602. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=22040620&lang=pt-br&site=ehost-live pmid:22040620
  50. 50. Haapalahti M, Mykkanen H, Tikkanen S, Kokkonen J. Meal patterns and food use in 10-to 11-year-old Finnish children. Public Health Nutr. 2003 Jun;6(4):365–70. pmid:12795824
  51. 51. Hong J, Kim M, Yoon J, Kim S. Nutritional Quality of Breakfast among Korean School-Aged Children and Adolescents Depending on Eating Together as a Family: Based on the Data from the 2013–2014 Korea National Health and Nutrition Survey. J Korean Soc Food Cult. 2019;34(4):378–88.
  52. 52. Larson NI, Neumark-Sztainer D, Hannan PJ, Story M. Family meals during adolescence are associated with higher diet quality and healthful meal patterns during young adulthood. J Am Diet Assoc [Internet]. 2007 Sep;107(9):1502–10. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=17761227&lang=pt-br&site=ehost-live pmid:17761227
  53. 53. Larson N, Wang Q, Berge JM, Shanafelt A, Nanney MS. Eating breakfast together as a family: mealtime experiences and associations with dietary intake among adolescents in rural Minnesota, USA. Public Health Nutr [Internet]. 2016 Jun;19(9):1565–74. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=26973150&lang=pt-br&site=ehost-live pmid:26973150
  54. 54. Leech RM, McNaughton SA, Crawford DA, Campbell KJ, Pearson N, Timperio A. Family food involvement and frequency of family dinner meals among Australian children aged 10–12 years. Cross-sectional and longitudinal associations with dietary patterns. Appetite [Internet]. 2014 Apr;75:64–70. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=24389242&lang=pt-br&site=ehost-live pmid:24389242
  55. 55. Lipsky LM, Haynie DL, Liu D, Chaurasia A, Gee B, Li K, et al. Trajectories of eating behaviors in a nationally representative cohort of US adolescents during the transition to young adulthood. Int J Behav Nutr Phys Act. 2015 Nov;12.
  56. 56. Lipsky LM, Nansel TR, Haynie DL, Liu D, Li K, Pratt CA, et al. Diet quality of US adolescents during the transition to adulthood: changes and predictors. Am J Clin Nutr. 2017 Jun;105(6):1424–32. pmid:28446498
  57. 57. Makansi N, Allison P, Awad M, Bedos C. Fruit and vegetable intake among Emirati adolescents: A mixed methods study. East Mediterr Heal J. 2018;24(7):653–63.
  58. 58. Martins BG, Ricardo CZ, Machado PP, Rauber F, Azeredo CM, Levy RB. Eating meals with parents is associaed with better quality of diets for Brazilian adolescents. Cad Saude Publica. 2019 Jul 22;35(7):e00153918. pmid:31340336
  59. 59. De Oliveira SS, Bauermann GM, Alves MR, Toral N. Association of dietary intake with eating behavior, screen time, and physical activity among Brazilian adolescents. Rev Chil Nutr. 2018;45(4):349–55.
  60. 60. Totland TH, Knudsen MD, Paulsen MM, Bjelland M, van’t Veer P, Brug J, et al. Correlates of irregular family meal patterns among 11-year-old children from the Pro Children study. FOOD Nutr Res. 2017;61. pmid:28680386
  61. 61. Walton K, Horton NJ, Rifas-Shiman SL, Field AE, Austin SB, Haycraft E, et al. Exploring the Role of Family Functioning in the Association Between Frequency of Family Dinners and Dietary Intake Among Adolescents and Young Adults. JAMA Netw open. 2018 Nov 2;1(7):e185217. pmid:30646382
  62. 62. Woodruff SJ, Hanning RM. Associations between family dinner frequency and specific food behaviors among grade six, seven, and eight students from Ontario and Nova Scotia. J Adolesc Heal Off Publ Soc Adolesc Med [Internet]. 2009 May;44(5):431–6. Available from: http://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=19380089&lang=pt-br&site=ehost-live
  63. 63. Woodruff SJ, Hanning RM, McGoldrick K, Brown KS. Healthy eating index-C is positively associated with family dinner frequency among students in grades 6–8 from Southern Ontario, Canada. Eur J Clin Nutr. 2010 May;64(5):454–60. pmid:20197788
  64. 64. Woodruff SJ, Campbell K, Campbell T, Cole M. The associations of meals and snacks on family meals among a sample of grade 7 students from Southwestern Ontario. Appetite. 2014 Nov;82:61–6. pmid:25038406
  65. 65. Verhage CL, Gillebaart M, van der Veek SMC, Vereijken CMJL. The relation between family meals and health of infants and toddlers: A review. Vol. 127, Appetite. Academic Press; 2018. p. 97–109.
  66. 66. Glanz K, Bishop DB. The Role of Behavioral Science Theory in Development and Implementation of Public Health Interventions. Annu Rev Public Health. 2010 Mar 17;31(1):399–418. pmid:20070207
  67. 67. Ma G. Food, eating behavior, and culture in Chinese society. J Ethn Foods. 2015 Dec 1;2(4):195–9.
  68. 68. World Health Organization. DIET, NUTRITION AND THE PREVENTION OF CHRONIC DISEASES. Geneva; 2003.
  69. 69. McCullough MB, Robson SM, Stark LJ. A Review of the Structural Characteristics of Family Meals with Children in the United States. Adv Nutr An Int Rev J. 2016 Jul;7(4):627–40.
  70. 70. Ferreira IB, Melo GRI, Toral N. Breakfast and its association with food consumption and anthropometric profile of adolescents in Brasilia -DF. Mundo da Saude. 2019;43(1):211–26.
  71. 71. Chen J-L, Kennedy C. Family Functioning, Parenting Style, and Chinese Children’s Weight Status. J Fam Nurs [Internet]. 2004 May 24 [cited 2020 May 7];10(2):262–79. Available from: http://journals.sagepub.com/doi/10.1177/1074840704264021
  72. 72. Olvera N, Power TG. Brief Report: Parenting Styles and Obesity in Mexican American Children: A Longitudinal Study. J Pediatr Psychol. 2010;35(3):243. pmid:19726552
  73. 73. Hammons AJ, Fiese BH. Is frequency of shared family meals related to the nutritional health of children and adolescents? Vol. 127, Pediatrics. American Academy of Pediatrics; 2011. p. e1565–74.
  74. 74. Gil Á, de Victoria EM, Olza J. Indicators for the evaluation of the diet quality. Nutr Hosp [Internet]. 2015 Feb 26 [cited 2020 May 7]; 31:128–44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25719781